Fine needle aspiration biopsy safe in uveal melanoma

Issue: April 25, 2017

A study carried out at Retina Consultants of Houston and Houston Methodist Hospital confirmed the safety of fine needle aspiration biopsy in patients with uveal melanoma. No tumor cells were found in the scleral tract of the needle or adjacent pars plana when histopathological analysis was performed after enucleation.

In the prospective study, which included 10 patients with uveal melanoma scheduled for enucleation, fine needle aspiration biopsy was carried out by manually inserting a 25-gauge or 27-gauge needle on a syringe through 23-gauge or 25-gauge valved trocars. Retinal viewing lenses and chandelier lighting were used to facilitate an upright view and video recording. After aspiration, cryotherapy was applied to the biopsy site.

The authors suggested that three aspects of the surgical technique might have contributed to the absence of tumor cells in the scleral tract of all 10 patients. First, the small-gauge trocar tract may contain the tumor cells, protecting the surrounding tissue. Second, effective viewing allowed the biopsy to be carried out with only one pass. Third, cryotherapy likely destroyed potential tumor cells present on the surface.

Fine needle aspiration biopsy can provide important diagnostic, prognostic and genomic information. It is widely adopted as a technique in the U.S. and Europe, but concerns about biopsy-induced extraocular extension of tumor cells have not been entirely dispelled, the authors noted.

“Nonetheless, this study continues to reaffirm the safety and reproducibility of this procedure for patients and should reassure clinicians and patients that the presence of extraocular extension caused by obtaining a biopsy specimen is a truly rare phenomenon,” they wrote. – by Michela Cimberle

Disclosure: The authors report no relevant financial disclosures.

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Source:

Kim RS, et al. Am J Ophthalmol. 2017;doi:10.1016/j.ajo.2016.10.019.