• Small Uveal Melanoma: Yield Rates and Other Traits of FNAB

    Written By: Lynda Seminara
    Selected By: Neil M. Bressler, MD, and Deputy Editors

    Journal Highlights

    JAMA Ophthalmology, May 2018

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    Assessing the adequacy of biopsy sam­ples intraoperatively may help to ensure appropriate cell yield, which can be challenging for small lesions. In a retro­spective study, Kim et al. documented yield rates for transscleral and trans­vitreal fine-needle aspiration biopsies (FNAB) of small uveal melanomas (apical height <3.6 mm); they found that intraoperative evaluation was as­sociated with high yield and a favorable safety profile.

    This observational study of consec­utive cases included 44 patients (mean age, 63.3 years) with uveal melanoma of the ciliary body or choroid. In all cases, FNAB and intraoperative his­topathologic analysis were performed before administration of iodine-125 (125I) brachytherapy. Tumor locations and dimensions were determined from B-scan ultrasonography and histo­pathologic analysis. Transscleral biopsy was performed for tumors anterior to the equator, and transvitreal biopsy was used for posterior lesions. The adequacy of each biopsy specimen was checked intraoperatively. Specimens underwent hematoxylin-eosin staining, double immunostaining with human melanoma black 45 and Ki67, and gene expression profiling.

    The median tumor height was 2.7 mm (interquartile range, 2.3-2.9 mm). Of the 44 biopsy samples, 40 (90.9%) contained ample cells for gene expres­sion analysis. Yield rates were 100% (11 of 11) for transscleral specimens and 87.9% (29 of 33) for transvitreal specimens.

    Localized vitreous hemorrhages occurred in 24 eyes, and most resolved within 3 months. A moderate associ­ation was observed between localized vitreous hemorrhage and the transvit­real biopsy method (phi value, −0.526; p < .001).

    As the role of genetic testing for uveal melanoma continues to expand, greater emphasis is being placed on ob­taining specimens of adequate size. The authors’ findings suggest that intraoperative assessment helps ensure that samples contain a sufficient number of cells for analysis. Their research also af­firms the safety and efficacy of FNAB as a diagnostic tool for uveal melanoma. Large prospective multicenter trials of various biopsy techniques are needed to determine the ones best suited for achieving high yield rates. The authors are participating in such an effort and plan to report their findings. (Also see related commentary by Carol L. Shields, MD, Arman Mashayekhi, MD, and Jerry A. Shields, MD, in the same issue.)

    The original article can be found here.