Clinical and radiological evaluations show poor accuracy for diagnosing orbital lesions

This study compares the accuracy of clinical and radiological diagnoses versus histological diagnoses in patients with orbital lesions.

Study design

The authors retrospectively analyzed data from 112 surgical orbital biopsies performed during a 12-year period. 

Outcomes

A correct preoperative diagnosis was reached in fewer than 50% of cases by both the ophthalmologist and radiologist. The accuracy of preoperative diagnosis was particularly low with regards to differentiating between inflammatory and hematological lesions, which represented half of the cases. Vascular lesions, however, were much more likely to have a correct preoperative diagnosis.

Limitations

The findings are interesting; however, the study is retrospective, includes a relatively low number of cases (about 10 orbital lesions per year) and involves multiple ophthalmologists and radiologists. The findings therefore may not clearly reflect the potential success rates that might be obtained by highly trained individuals with greater experience. In addition, imaging technology has significantly changed over 12 years. A prospective study with strict clinical and radiological criteria may give a more accurate result using standardized imaging and clinical protocols. 

Clinical significance

This study supports the use of open orbital biopsy in the diagnosis and management of orbital lesions. However, with newer imaging protocols and the availability of fine-needle aspiration biopsy, open biopsy is likely not the future of orbital lesion management.