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Better technology reduces misdiagnoses leading to pediatric enucleation

Arch Ophth. 2010;128(8):1009-1013.

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Misdiagnoses that lead to pediatric enucleation have decreased, most likely due to improved diagnostic techniques, a study said.

Researchers reviewed 27,422 pathology reports from one institution to identify pediatric enucleation specimens from 1960 to 2008. Of the 746 eyes that underwent enucleation, 4% had discordant clinical and pathological diagnoses.

Histopathology revealed 6% of eyes enucleated for malignant clinical indications were benign, and 1.9% of eyes enucleated for benign clinical indications were malignant.

However, the rate of misdiagnosis decreased steadily in the past 5 decades, with the highest rate in the 1960s (6.5%) and no misdiagnoses from 1990 to 2008. Study authors attributed the decline to the development and innovation of ophthalmic ultrasonography, tomography and MRI.

"Even with advanced technologies, some cases may still be difficult to differentiate," the study authors said. "This study reminds ophthalmologists that, in children, benign and malignant intraocular conditions can simulate each other, especially retinoblastoma, Coats' disease, Toxocara infection, other types of endophthalmitis, panuveitis and [persistent hyperplastic primary vitreous]."