Fine-Needle Aspiration Biopsy
Intraocular fine-needle aspiration biopsy (FNAB) is not routinely used in the diagnosis of uveal tumors, as examination and use of noninvasive imaging techniques can accurately identify most tumors. In cases of diagnostic uncertainty or for genetic prognostic testing, FNAB can be employed. The procedure is performed under direct visualization through a dilated pupil, transvitreally (Video 17-1) or transsclerally (Video 17-2). Iris tumors may be accessible for FNAB through a transcameral approach. The cells obtained through FNAB can be evaluated for cytologic features to assist in diagnosis. More commonly, FNABs are performed for prognostic purposes in tumors clinically diagnosed as uveal melanomas. In this clinical scenario, cells obtained from FNAB are processed to extract the RNA or DNA for molecular testing and determine risk for metastasis. A variety of techniques may be used, including chromosomal analysis and gene expression profiling (see Chapter 3).
Intraocular FNAB may potentially allow tumor cells to exit the eye, although this concept is controversial. In general, a properly performed FNAB does not pose a major risk for seeding tumors. However, retinoblastoma is a notable exception. If a retinoblastoma is suspected, FNAB is avoided.
VIDEO 17-1 Transvitreal fine-needle aspiration biopsy.
Courtesy of Thomas Aaberg Jr, MD.
Go to www.aao.org/bcscvideo_section04 to access all videos in Section 4.
VIDEO 17-2 Transscleral fine-needle aspiration biopsy.
Courtesy of Thomas Aaberg Jr, MD.
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Finn AP, Materin MA, Mruthyunjaya P. Choroidal tumor biopsy: a review of the current state and a glance into future techniques. Retina. 2018;38(Suppl 1):S79–S87.
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McCannel TA, Chang MY, Burgess BL. Multi-year follow-up of fine-needle aspiration biopsy in choroidal melanoma. Ophthalmology. 2012;119(3):606–610.
Excerpted from BCSC 2020-2021 series: Section 4 - Ophthalmic Pathology and Intraocular Tumors. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.