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Berry JL, Pike S, Shah R, Reid MW, Peng CC, Wang Y, Yellapantula V, Biegel J, Kuhn P, Hicks J, Xu L. Aqueous Humor Liquid Biopsy as a Companion Diagnostic for Retinoblastoma: Implications for Diagnosis, Prognosis, and Therapeutic Options: Five Years of Progress. Am J Ophthalmol 2023; 263:188-205. [PMID: 38040321 DOI: 10.1016/j.ajo.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE To define the prospective use of the aqueous humor (AH) as a molecular diagnostic and prognostic liquid biopsy for retinoblastoma (RB). METHODS This is a prospective, observational study wherein an AH liquid biopsy is performed at diagnosis and longitudinally through therapy for patients with RB. Tumor-derived cell-free DNA is isolated and sequenced for single nucleotide variant analysis of the RB1 gene and detection of somatic copy number alterations (SCNAs). The SCNAs are used to determine tumor fraction (TFx). Specific SCNAs, including 6p gain and focal MycN gain, along with TFx, are prospectively correlated with intraocular tumor relapse, response to therapy, and globe salvage. RESULTS A total of 26 eyes of 21 patients were included with AH taken at diagnosis. Successful ocular salvage was achieved in 19 of 26 (73.1%) eyes. Mutational analysis of 26 AH samples identified 23 pathogenic RB1 variants and 2 focal RB1 deletions; variant allele fraction ranged from 30.5% to 100% (median 93.2%). At diagnosis, SCNAs were detectable in 17 of 26 (65.4%) AH samples. Eyes with 6p gain and/or focal MycN gain had significantly greater odds of poor therapeutic outcomes (odds ratio = 6.75, 95% CI = 1.06-42.84, P = .04). Higher AH TFx was observed in eyes with vitreal progression (TFx = 46.0% ± 40.4) than regression (22.0 ± 29.1; difference: -24.0; P = .049). CONCLUSIONS Establishing an AH liquid biopsy for RB is aimed at addressing (1) our inability to biopsy tumor tissue and (2) the lack of molecular biomarkers for intraocular prognosis. Current management decisions for RB are made based solely on clinical features without objective molecular testing. This prognostic study shows great promise for using AH as a companion diagnostic. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- Jesse L Berry
- From the Vision Center, Children's Hospital Los Angeles (J.L.B., S.P., M.W.R., C.-C.P., L.X.); USC Roski Eye Institute, Keck School of Medicine of the University of Southern California (J.L.B., S.P., M.W.R., C.-C.P., L.X.); the Saban Research Institute, Children's Hospital Los Angeles (J.L.B., V.Y., J.B., L.X.); Norris Comprehensive Cancer Center, Keck School of Medicine of the University of Southern California (J.L.B., P.K., J.H.).
| | - Sarah Pike
- From the Vision Center, Children's Hospital Los Angeles (J.L.B., S.P., M.W.R., C.-C.P., L.X.); USC Roski Eye Institute, Keck School of Medicine of the University of Southern California (J.L.B., S.P., M.W.R., C.-C.P., L.X.)
| | - Rachana Shah
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles (R.S.)
| | - Mark W Reid
- From the Vision Center, Children's Hospital Los Angeles (J.L.B., S.P., M.W.R., C.-C.P., L.X.); USC Roski Eye Institute, Keck School of Medicine of the University of Southern California (J.L.B., S.P., M.W.R., C.-C.P., L.X.)
| | - Chen-Ching Peng
- From the Vision Center, Children's Hospital Los Angeles (J.L.B., S.P., M.W.R., C.-C.P., L.X.); USC Roski Eye Institute, Keck School of Medicine of the University of Southern California (J.L.B., S.P., M.W.R., C.-C.P., L.X.)
| | - Yingfei Wang
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles (R.S.); Department of Quantitative and Computational Biology, University of Southern California (Y.W.)
| | - Venkata Yellapantula
- the Saban Research Institute, Children's Hospital Los Angeles (J.L.B., V.Y., J.B., L.X.); Center for Personalized Medicine, Children's Hospital Los Angeles (V.Y., J.B.)
| | - Jaclyn Biegel
- the Saban Research Institute, Children's Hospital Los Angeles (J.L.B., V.Y., J.B., L.X.)
| | - Peter Kuhn
- Norris Comprehensive Cancer Center, Keck School of Medicine of the University of Southern California (J.L.B., P.K., J.H.); USC Michelson Center for Convergent Biosciences and Department of Biological Sciences (P.K., J.H.), Los Angeles, California, USA
| | - James Hicks
- Norris Comprehensive Cancer Center, Keck School of Medicine of the University of Southern California (J.L.B., P.K., J.H.); USC Michelson Center for Convergent Biosciences and Department of Biological Sciences (P.K., J.H.), Los Angeles, California, USA
| | - Liya Xu
- From the Vision Center, Children's Hospital Los Angeles (J.L.B., S.P., M.W.R., C.-C.P., L.X.); USC Roski Eye Institute, Keck School of Medicine of the University of Southern California (J.L.B., S.P., M.W.R., C.-C.P., L.X.); the Saban Research Institute, Children's Hospital Los Angeles (J.L.B., V.Y., J.B., L.X.)
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Busch MA, Haase A, Alefeld E, Biewald E, Jabbarli L, Dünker N. Trefoil Family Factor Peptide 1-A New Biomarker in Liquid Biopsies of Retinoblastoma under Therapy. Cancers (Basel) 2023; 15:4828. [PMID: 37835522 PMCID: PMC10571905 DOI: 10.3390/cancers15194828] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/01/2023] [Accepted: 09/14/2023] [Indexed: 10/15/2023] Open
Abstract
Effective management of retinoblastoma (RB), the most prevalent childhood eye cancer, depends on reliable monitoring and diagnosis. A promising candidate in this context is the secreted trefoil family factor peptide 1 (TFF1), recently discovered as a promising new biomarker in patients with a more advanced subtype of retinoblastoma. The present study investigated TFF1 expression within aqueous humor (AH) of enucleated eyes and compared TFF1 levels in AH and corresponding blood serum samples from RB patients undergoing intravitreal chemotherapy (IVC). TFF1 was consistently detectable in AH, confirming its potential as a biomarker. Crucially, our data confirmed that TFF1-secreting cells within the tumor mass originate from RB tumor cells, not from surrounding stromal cells. IVC-therapy-responsive patients exhibited remarkably reduced TFF1 levels post-therapy. By contrast, RB patients' blood serum displayed low-to-undetectable levels of TFF1 even after sample concentration and no therapy-dependent changes were observed. Our findings suggest that compared with blood serum, AH represents the more reliable source of TFF1 if used for liquid biopsy RB marker analysis in RB patients. Thus, analysis of TFF1 in AH of RB patients potentially provides a minimally invasive tool for monitoring RB therapy efficacy, suggesting its importance for effective treatment regimens.
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Affiliation(s)
- Maike Anna Busch
- Institute of Anatomy II, Department of Neuroanatomy, Medical Faculty, Center for Translational Neuro and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, 45147 Essen, Germany; (A.H.); (E.A.); (N.D.)
| | - André Haase
- Institute of Anatomy II, Department of Neuroanatomy, Medical Faculty, Center for Translational Neuro and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, 45147 Essen, Germany; (A.H.); (E.A.); (N.D.)
| | - Emily Alefeld
- Institute of Anatomy II, Department of Neuroanatomy, Medical Faculty, Center for Translational Neuro and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, 45147 Essen, Germany; (A.H.); (E.A.); (N.D.)
| | - Eva Biewald
- Department of Ophthalmology, Children’s Hospital, University of Duisburg-Essen, 45147 Essen, Germany; (E.B.); (L.J.)
| | - Leyla Jabbarli
- Department of Ophthalmology, Children’s Hospital, University of Duisburg-Essen, 45147 Essen, Germany; (E.B.); (L.J.)
| | - Nicole Dünker
- Institute of Anatomy II, Department of Neuroanatomy, Medical Faculty, Center for Translational Neuro and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, 45147 Essen, Germany; (A.H.); (E.A.); (N.D.)
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Mazzeo TJMM, Cristina Mendonça Freire R, Guimarães Machado C, Gomes AMV, Curi ALL. Vitreoretinal Surgery in Uveitis: From Old to New Concepts - A Review. Ocul Immunol Inflamm 2023:1-14. [PMID: 37093650 DOI: 10.1080/09273948.2023.2193842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
PURPOSE The aim of this article is to do a comprehensive literature review about the current role of pars plana vitrectomy in uveitis and in its different structural complications such as cystoid macular edema, epiretinal membrane, macular hole, and retinal detachment. METHODS This comprehensive literature review was performed based on a search on PubMed, BioMed Central, Science Open, and CORE databases, of relevant articles abording pars plana vitrectomy in uveitis. DISCUSSION Uveitis is a complex disease with multiple etiologies and pathogenic mechanisms. Therapeutic pars plana vitrectomy (PPV) may aid in uveitic structural complications such as cystoid macular edema, epiretinal membranes, macular hole, and retinal detachments even though some cases may present unpredictable visual outcomes. Diagnostic PPV with appropriate ancillary testing is also a valuable tool for the assessment and diagnosis of uveitis in a large proportion of patients. CONCLUSION Over the years, pars plana vitrectomy has undergone significant transformations since its invention nearly 5 decades ago, however, the quality of evidence in the literature regarding its use for uveitis has not improved in the same way. Even though some structural uveitis complications (as previously mentioned) may respond well to surgery, there is still a certain unpredictability regarding its visual outcomes. On the other hand, diagnostic vitrectomy with appropriate ancillary testing is also a valuable tool for the assessment and diagnosis of uveitis in a large proportion of patients.
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Affiliation(s)
| | | | - Cleide Guimarães Machado
- Retina and Vitreous Department, Suel Abujamra Institute, São Paulo, Brazil
- Retina and Vitreous Department, University of São Paulo (USP), São Paulo, Brazil
| | | | - André Luiz Land Curi
- Clinical Research Laboratory of Infectious Diseases in Ophthalmology, National Institute of Infectious Diseases (INI - Fiocruz), Rio de Janeiro, Brazil
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Hussain RN, Damato B, Heimann H. Choroidal biopsies; a review and optimised approach. Eye (Lond) 2023; 37:900-906. [PMID: 35941182 PMCID: PMC10050311 DOI: 10.1038/s41433-022-02194-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 11/09/2022] Open
Abstract
The majority of choroidal tumours are diagnosed accurately with clinical examination and the additional data obtained from non-invasive imaging techniques. Choroidal biopsies may be undertaken for diagnostic clarity in cases such as small melanocytic or indeterminate lesions, identifying the primary tumour in the case of choroidal metastases or the subclassification of rarer conditions such as uveal lymphoma. There is however an increasing use of biopsy techniques for prognostication in uveal melanoma. This review explores the main indications and surgical techniques for tumour acquisition, and the optimised approach utilised by the current authors to improve successful yield for histological and genetic analysis.
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Affiliation(s)
- R N Hussain
- Liverpool Ocular Oncology Centre, Royal Liverpool Hospital, Liverpool, L7 8XP, UK.
| | - B Damato
- Ocular Oncology Service, Moorfields Eye Hospital, London, EC1V 2PD, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, EC1V 2PD, UK
| | - H Heimann
- Liverpool Ocular Oncology Centre, Royal Liverpool Hospital, Liverpool, L7 8XP, UK
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Snyder LL, Daniels AB. Surgical Technique, Indications, and Outcomes of BIOM-Assisted Transvitreal Biopsy for Uveal Melanoma. Retina 2022; 42:2229-2235. [PMID: 31815876 PMCID: PMC8117563 DOI: 10.1097/iae.0000000000002677] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Controversy exists regarding the best method for biopsy of uveal melanoma. We describe our transvitreal technique and evaluate the safety of this technique as well as the efficacy for obtaining sample for prognostic genetic profiling. METHODS Description of surgical technique and retrospective case series. Medical records for uveal melanoma patients who underwent transvitreal biopsy using our described technique were analyzed for tumor size, location, primary treatment, method of biopsy, and any complications thereof. Characteristics of tumors that underwent transvitreal biopsy were noted including tumor size, location, or presence of subretinal fluid, to see whether these affected surgeon preference for biopsy modality. A cohort of contemporaneous uveal melanoma patients who underwent biopsy through a transscleral technique served as a comparator group for these patient, tumor, and complication factors. RESULTS A total of 27 patients aged 27.2 to 88.6 years (mean 64.8) underwent transvitreal biopsy using our described technique between 2013 and 2016. There were 15 small, 10 medium, and 2 large tumors at diagnosis with the majority (n = 17) posterior to the equator. Intraoperative complications included a clot or small trickle of blood at the biopsy site in 20 (74.1%) of patients, small localized subretinal hemorrhage in 8 (29.6%), small vitreous hemorrhage in 4 (14.8%), and small transient choroidal detachments in 1 patient (3.6%). When subretinal hemorrhage occurred, it was almost always into a pre-existing pocket of subretinal fluid ( P = 0.0093). However, the presence of subretinal fluid was not associated with the decision to proceed with any biopsy ( P = 0.36) or transvitreal biopsy specifically ( P = 1.00). By 3 months, subretinal and/or vitreous hemorrhage resolved in essentially all cases. There were no cases of iatrogenic retinal detachment or extraocular tumor spread over a mean follow-up of 41.7 (range: 20-62.1) months. Adequate tissue for gene expression profiling was obtained from each biopsy. The comparator group of patients undergoing transscleral biopsy including 21 uveal melanomas in 20 patients (one eye had two melanomas). Transvitreal biopsies were more common in patients with small (n = 15; P < 0.0001), posterior (n = 17; P < 0.0001) tumors, compared with patients who underwent transscleral biopsy during the same period. CONCLUSION This technique can be used for small or posterior tumors or for small anterior tumors where a transscleral approach would risk tumor perforation. Complications were minor, transient, and self-limited. Biopsy yields for molecular prognosis were adequate in all cases. The presence of subretinal fluid may be considered a relative contraindication because it may lead to subretinal hemorrhage in the fluid pocket but did not dissuade us from using this transvitreal technique for patients who would benefit from it.
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Affiliation(s)
- Laura L. Snyder
- Department of Ophthalmology & Visual Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Anthony B. Daniels
- Department of Ophthalmology & Visual Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
- Program in Cancer Biology, Vanderbilt University, Nashville, TN, United States
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, United States
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, United States
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Liu J, Xu X, Yan J, Guo J, Wang X, Xian J. Diffusion‐Weighted
MR
Imaging of the Optic Nerve Can Improve the Detection of Post‐Laminar Optic Nerve Invasion from Retinoblastoma. J Magn Reson Imaging 2022; 57:1587-1593. [PMID: 36106682 DOI: 10.1002/jmri.28429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/30/2022] [Accepted: 08/30/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Post-laminar optic nerve invasion (PLONI) is a high-risk factor for the metastasis of retinoblastoma (RB). Unlike conventional MRI, diffusion-weighted imaging (DWI) reflects histopathological features, and may aid the assessment of PLONI. PURPOSE To determine the value of conventional MRI plus DWI in detecting PLONI in RB patients. STUDY TYPE Retrospective. POPULATION Eighty-three RB patients, including 28 with histopathologically proven PLONI and 55 without PLONI. FIELD STRENGTH/SEQUENCE 3.0 T, precontrast axial T1-weighted and T2-weighted imaging, DWI, and postcontrast axial, coronal, and oblique-sagittal T1-weighted imaging. ASSESSMENT PLONI was assessed using post-enucleation histology and preoperative MRI features (optic nerve signal intensity, enlargement, and enhancement on conventional MRI, and apparent diffusion coefficient [ADC] of the optic nerve on DWI) evaluated by three observers. STATISTICAL TESTS MRI features suggesting the presence of PLONI were identified using univariable and multivariable analyses. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to analyze diagnostic performance. RESULTS Optic nerve enhancement and low ADC of the optic nerve were significant indicators of PLONI. ROC curve analysis showed that the AUC of the combination of these two features for detecting PLONI was 0.87 (95% confidence interval [CI]: 0.78-0.93). The diagnostic performance of this model was significantly superior to that of optic nerve enhancement alone (0.76, 95% CI: 0.65-0.85) and marginally superior to that of the ADC of the affected optic nerve (0.78, 95% CI: 0.68-0.87, P = 0.051). DATA CONCLUSION Conventional MRI combined with DWI can improve the detection of PLONI in RB patients over conventional MRI alone. EVIDENCE LEVEL 3 Technical Efficacy: Stage 2.
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Affiliation(s)
- Jing Liu
- Department of Radiology Beijing Tongren Hospital, Capital Medical University Beijing China
- Dongfang Hospital, Beijing University of Chinese Medicine Beijing China
| | - Xiaolin Xu
- Institute of Ophthalmology, Beijing Tongren Eye Center Beijing Tongren Hospital, Capital Medical University Beijing China
| | - Jing Yan
- Dongfang Hospital, Beijing University of Chinese Medicine Beijing China
| | - Jian Guo
- Department of Radiology Beijing Tongren Hospital, Capital Medical University Beijing China
| | - XinYan Wang
- Department of Radiology Beijing Tongren Hospital, Capital Medical University Beijing China
| | - Junfang Xian
- Department of Radiology Beijing Tongren Hospital, Capital Medical University Beijing China
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Fine Needle Aspiration Biopsy for Intraocular Tumors: Why and When. CURRENT OPHTHALMOLOGY REPORTS 2022. [DOI: 10.1007/s40135-022-00284-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fu W, Zheng S, Zhou J, Lu K, Lu Y, Guo G. Male Breast Carcinoma Metastatic to the Choroid: A Case Report and Opinions of Management. Cancer Manag Res 2022; 14:525-534. [PMID: 35173486 PMCID: PMC8841333 DOI: 10.2147/cmar.s345078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/25/2022] [Indexed: 11/23/2022] Open
Abstract
Male breast carcinoma metastatic to the choroid is very rare and often related to poor prognosis. Herein, we report the findings in a Chinese male breast cancer patient who developed choroidal metastasis, and give opinions on systemic treatments. A 45-year-old Chinese male represented with difficulty breathing and visual impairment in the left eye 6 years after his breast cancer surgery and postoperative adjuvant treatment. PET/CT revealed multi-organs metastasis of the patient. The IHC indicated the lung lesion to be originated from the breast (ER+/PR+/HER2-). Eye examination provided evidence for breast cancer choroidal metastasis. Two cycles of TX (docetaxel + capecitabine) followed by two courses of GP (gemcitabine + cis-platinum) were applied as salvage chemotherapy. Metastases in his lung and bone remained stable. As for choroidal metastasis, a regimen of CDK4/6 inhibitor (Palbociclib) plus fulvestrant was recommended to the patient, which led to a good response. Notably, CDK4/6 inhibitor combined with endocrine therapy may be considered as an effective treatment for hormonal receptor-positive breast cancer patients with choroidal metastasis. We recommend that eye examination should not be neglected in breast cancer patients.
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Affiliation(s)
- Weida Fu
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Shurong Zheng
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Jieyu Zhou
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Kangkang Lu
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Yiqiao Lu
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Guilong Guo
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
- Correspondence: Guilong Guo, Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China, Tel/Fax +86-13867709361, Email
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Busch MA, Haase A, Miroschnikov N, Doege A, Biewald E, Bechrakis NE, Beier M, Kanber D, Lohmann D, Metz K, Dünker N. TFF1 in Aqueous Humor—A Potential New Biomarker for Retinoblastoma. Cancers (Basel) 2022; 14:cancers14030677. [PMID: 35158945 PMCID: PMC8833755 DOI: 10.3390/cancers14030677] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 11/29/2022] Open
Abstract
Simple Summary Retinoblastoma is the most common pediatric intraocular malignancy with high cure rates in developed countries. Nevertheless, useful predictive biomarkers providing reliable evidence for therapy decisions are urgently needed to optimize therapy regimes. TFF1 is a promising candidate as it is expressed in a more advanced subtype of retinoblastoma. Additionally, TFF1 is a naturally secreted peptide. Thus, TFF1 might be detectable in the aqueous humor of RB patients’ eyes, providing the opportunity to determine its expression prior to therapy without the necessity of a tumor biopsy. We therefore investigated for the first time aqueous humor samples of retinoblastoma patients in order to test for the availably and expression status of TFF1 as well as to compare it with the original tumor and established corresponding primary cell cultures. Abstract Retinoblastoma (RB) is the most common childhood eye cancer. The expression of trefoil factor family peptide 1 (TFF1), a small secreted peptide, has been correlated with more advanced RB stages and it might be a promising new candidate as a RB biomarker. The study presented addressed the question of if TFF1 is detectable in aqueous humor (AH) of RB patients’ eyes, providing easy accessibility as a diagnostic and/or therapy accompanying predictive biomarker. The TFF1 expression status of 15 retinoblastoma AH samples was investigated by ELISA and Western blot analyses. The results were correlated with the TFF1 expression status in the tumor of origin and compared to TFF1 expression in established corresponding primary tumor cell cultures and supernatants. Nine out of fifteen AH patient samples exhibited TFF1 expression, which correlated well with TFF1 levels of the original tumor. TFF1 expression in most of the corresponding primary cell cultures reflects the levels of the original tumor, although not all TFF1-expressing tumor cells seem to secret into the AH. Together, our findings strongly suggest TFF1 as a reliable new RB biomarker.
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Affiliation(s)
- Maike Anna Busch
- Center for Translational Neuro- and Behavioral Sciences, Institute of Anatomy II, Department of Neuroanatomy, Medical Faculty, University of Duisburg-Essen, 45147 Essen, Germany; (A.H.); (N.M.); (A.D.); (N.D.)
- Correspondence: ; Tel.: +49-201-7238-4434
| | - André Haase
- Center for Translational Neuro- and Behavioral Sciences, Institute of Anatomy II, Department of Neuroanatomy, Medical Faculty, University of Duisburg-Essen, 45147 Essen, Germany; (A.H.); (N.M.); (A.D.); (N.D.)
| | - Natalia Miroschnikov
- Center for Translational Neuro- and Behavioral Sciences, Institute of Anatomy II, Department of Neuroanatomy, Medical Faculty, University of Duisburg-Essen, 45147 Essen, Germany; (A.H.); (N.M.); (A.D.); (N.D.)
| | - Annika Doege
- Center for Translational Neuro- and Behavioral Sciences, Institute of Anatomy II, Department of Neuroanatomy, Medical Faculty, University of Duisburg-Essen, 45147 Essen, Germany; (A.H.); (N.M.); (A.D.); (N.D.)
| | - Eva Biewald
- Department of Ophthalmology, Medical Faculty, University of Duisburg-Essen, 45147 Essen, Germany; (E.B.); (N.E.B.)
| | - Nikolaos E. Bechrakis
- Department of Ophthalmology, Medical Faculty, University of Duisburg-Essen, 45147 Essen, Germany; (E.B.); (N.E.B.)
| | - Manfred Beier
- Institute of Human Genetics, Medical Faculty, Heinrich-Heine University, 40225 Düsseldorf, Germany;
| | - Deniz Kanber
- Institute of Human Genetics, Medical Faculty, University of Duisburg-Essen, 45147 Essen, Germany; (D.K.); (D.L.)
| | - Dietmar Lohmann
- Institute of Human Genetics, Medical Faculty, University of Duisburg-Essen, 45147 Essen, Germany; (D.K.); (D.L.)
| | - Klaus Metz
- Institute of Pathology, Medical Faculty, University of Duisburg-Essen, 45147 Essen, Germany;
| | - Nicole Dünker
- Center for Translational Neuro- and Behavioral Sciences, Institute of Anatomy II, Department of Neuroanatomy, Medical Faculty, University of Duisburg-Essen, 45147 Essen, Germany; (A.H.); (N.M.); (A.D.); (N.D.)
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Inter-eye genomic heterogeneity in bilateral retinoblastoma via aqueous humor liquid biopsy. NPJ Precis Oncol 2021; 5:73. [PMID: 34316014 PMCID: PMC8316348 DOI: 10.1038/s41698-021-00212-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/04/2021] [Indexed: 01/08/2023] Open
Abstract
Germline alterations in the RB1 tumor suppressor gene predispose patients to develop retinoblastoma (RB) in both eyes. While similar treatment is given for each eye, there is often a variable therapeutic response between the eyes. Herein, we use the aqueous humor (AH) liquid biopsy to evaluate the cell-free tumor DNA (ctDNA) from each eye in a patient with bilateral RB. Despite the same predisposing germline RB1 mutation, AH analysis identified a different somatic RB1 mutation as well as separate and distinct chromosomal alterations in each eye. The longitudinal alterations in tumor fraction (TFx) corresponded to therapeutic responses in each eye. This case demonstrates that bilateral RB tumors develop separate genomic alterations, which may play a role in tumorigenesis and prognosis for eye salvage. Identifying these inter-eye differences without the need for enucleated tumor tissue may help direct active management of RB, with particular usefulness in bilateral cases.
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Hemorrhagic choroidal detachment as the presenting sign of uveal melanoma. Am J Ophthalmol Case Rep 2021; 23:101173. [PMID: 34368497 PMCID: PMC8326186 DOI: 10.1016/j.ajoc.2021.101173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/25/2021] [Accepted: 07/19/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe two cases of medium-sized uveal melanoma presenting with hemorrhagic choroidal detachments. Observations The first case is a 39-year-old man who presented with choroidal hemorrhage and angle closure glaucoma. The second case is a 42-year-old man who presented with choroidal hemorrhage and posterior scleritis. Vitrectomy with transvitreous fine needle aspiration biopsy was ultimately required to diagnose malignant uveal melanoma in each case. Conclusions and importance Intraocular hemorrhage is a rare presenting sign of uveal melanoma. When it does occur, it is typically associated with large tumors. Hemorrhagic choroidal detachments are particularly rare in uveal melanoma, and can limit the diagnostic utility of clinical exam, B-scan ultrasonography, and magnetic resonance imaging. Although it is uncommon, it is important to maintain a high index of suspicion for choroidal melanoma in any patient with unexplained choroidal hemorrhage.
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Wang M, Levy G, Qin X, Adeniran AJ, Cai G. Fine-Needle Aspiration Biopsy of Intraocular Mass-Like Lesions. Am J Clin Pathol 2021; 156:268-277. [PMID: 33609033 DOI: 10.1093/ajcp/aqaa235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate the diagnostic performance of fine-needle aspiration (FNA) biopsy for intraocular mass-like lesions and its contributing factors. METHODS Intraocular FNA cases were retrieved and reviewed along with histopathologic follow-ups, if available. The effects of rapid on-site evaluation (ROSE), repeated biopsy, and adjunct immunocytochemical studies on cytologic diagnoses were analyzed. RESULTS Of 72 FNA biopsies from 63 patients, nondiagnostic biopsy was seen in 17 cases (24%), whereas a definitive diagnosis was rendered in 39 cases (54%). The cytologic diagnoses correlated well with histopathologic follow-ups with a concordance rate of 61%. Almost all nondiagnostic biopsies (16/17, 94%) were seen in cases in which ROSE was not performed. Of the 7 patients in whom biopsy was repeated, a definitive diagnosis was rendered in 4 cases (57%). Immunocytochemistry was performed in the majority of cases with a malignant diagnosis, especially in metastatic tumors (75%). CONCLUSIONS Our data demonstrates that FNA is an effective tool for the diagnosis of intraocular tumors. ROSE, repeated biopsy, and adjunct immunocytochemistry can help reduce the nondiagnostic rate and/or enhance diagnosis of malignancy, further improving FNA diagnostic performance.
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Affiliation(s)
- Minhua Wang
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Gillian Levy
- Department of Pathology, Norwalk Hospital, Norwalk, CT, USA
| | - Xiaoyi Qin
- Wenzhou Medical University Eye Hospital, Wenzhou, China
| | | | - Guoping Cai
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
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13
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Abstract
An intraocular biopsy is performed for diagnostic, prognostic and investigational purposes. Biopsies help to confirm or exclude malignancies and differentiate inflammatory from infectious processes. Histopathological analysis is the final verdict in unresponsive uveitis, atypical inflammation, metastases and masquerade syndromes. Advances and refinement of techniques in cytopathology, immunohistochemistry, microbiological and molecular biologic study offer much more than just diagnosis. They provide prognosis based on cell characteristics and are helpful in planning treatment and intervention. Many biopsy procedures have evolved to provide more safety and minimise complications thus improving the quality of specimens or samples available for analysis. The type of biopsy and technique adopted varies based on the clinical suspicion, size and location of lesions. In uveitis, a working diagnosis of intraocular inflammation is made on clinical examination and laboratory investigations and ancillary tests. Malignancy and uveitis is interlinked and masquerade syndromes are among the commonest indications for biopsy and analysis of specimen. The various types of intraocular biopsies include aqueous tap, fine needle aspiration biopsy, vitreous biopsy, iris and ciliary body, and retinochoroidal biopsy. They will be reviewed in this article with respect to current perspective
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Affiliation(s)
- Gazal Patnaik
- Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai, India
| | - Radha Annamalai
- Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India
| | - Jyotirmay Biswas
- Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai, India
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14
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Oprean CM, Badau LM, Segarceanu NA, Ciocoiu AD, Rivis IA, Vornicu VN, Hoinoiu T, Grujic D, Bredicean C, Dema A. Unilateral Orbital Metastasis as the Unique Symptom in the Onset of Breast Cancer in a Postmenopausal Woman: Case Report and Review of the Literature. Diagnostics (Basel) 2021; 11:725. [PMID: 33921735 PMCID: PMC8073535 DOI: 10.3390/diagnostics11040725] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 01/08/2023] Open
Abstract
The orbit represents an unusual metastases site for patients diagnosed with cancer, however, breast cancer is the main cause of metastases at this level. These orbital metastases were discovered in patients with a history of breast cancer as unique or synchronous lesions. We present a rare case of a unique retroocular metastasis as the first initial symptom of a tubulo-lobular mammary carcinoma in a postmenopausal woman. A 57-year-old patient complains of diplopia, diminishing visual acuity, orbital tenderness, slight exophthalmia and ptosis of the left eyelid, with insidious onset. Clinical examination and subsequent investigations revealed a left breast cancer cT2 cN1 pM1 stage IV. Breast conserving surgery was performed on the left breast. Pathological examination with immunohistochemistry staining established the complete diagnostic: pT2pN3aM1 Stage IV breast cancer, luminal B subtype. After two years from the initial breast cancer diagnosis, the patient was diagnosed by the psychiatrist with a depressive disorder and was treated accordingly. Orbital metastases are usually discovered in known breast cancer patients and they are found in the context of a multi-system end-stage disease. Most reports cite that up to 25% of the total orbital metastases cases are discovered before the diagnosis of the primary tumor, as our case did. MRI is the gold standard for evaluating orbital tumors. The ILC histological subtype metastasizes in the orbitals more frequently than invasive ductal carcinoma. The prognosis of patients with orbital metastases is poor. The median survival after diagnosis of orbital metastases from a breast cancer primary is ranging from 22 to 31 months. Overall survival of our patient was 56 months, longer than the median survival reported in literature. Orbital metastases must be taken into account when patients accuse ophthalmologic symptoms even in the absence of a personal history of cancer. Objective examination of every patient that incriminates these types of symptoms is essential, and breast palpation must be made in every clinical setting. Orbital biopsy is necessary for the confirmation of the diagnosis and for an adequate treatment. Although recommendations for management of orbital metastases are controversial, it appears that multidisciplinary treatment of both metastases and primary cancer improves overall survival.
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Affiliation(s)
- Cristina Marinela Oprean
- Morphopathology Department, “Victor Babeş” University of Medicine and Pharmacy, Eftimie Murgu Sq. Nr.2, 300041 Timişoara, Romania; (C.M.O.); (A.D.)
- Department of Oncology—ONCOHELP Hospital Timisoara, Ciprian Porumbescu Street, No. 59, 300239 Timisoara, Romania; (L.M.B.); (N.A.S.); (A.D.C.); (V.N.V.)
- Department of Oncology—ONCOMED Outpatient Unit Timisoara, Ciprian Porumbescu Street, No. 59, 300239 Timisoara, Romania
| | - Larisa Maria Badau
- Department of Oncology—ONCOHELP Hospital Timisoara, Ciprian Porumbescu Street, No. 59, 300239 Timisoara, Romania; (L.M.B.); (N.A.S.); (A.D.C.); (V.N.V.)
- Hygiene Department, “Victor Babeş” University of Medicine and Pharmacy, Eftimie Murgu Sq. No.2, 300041 Timişoara, Romania
| | - Nusa Alina Segarceanu
- Department of Oncology—ONCOHELP Hospital Timisoara, Ciprian Porumbescu Street, No. 59, 300239 Timisoara, Romania; (L.M.B.); (N.A.S.); (A.D.C.); (V.N.V.)
- Department of Oncology—ONCOMED Outpatient Unit Timisoara, Ciprian Porumbescu Street, No. 59, 300239 Timisoara, Romania
| | - Andrei Dorin Ciocoiu
- Department of Oncology—ONCOHELP Hospital Timisoara, Ciprian Porumbescu Street, No. 59, 300239 Timisoara, Romania; (L.M.B.); (N.A.S.); (A.D.C.); (V.N.V.)
| | - Ioana Alexandra Rivis
- Neurosciences Department, “Carol Davila” University of Medicine and Pharmacy of Bucharest, 020021 Bucharest, Romania;
| | - Vlad Norin Vornicu
- Department of Oncology—ONCOHELP Hospital Timisoara, Ciprian Porumbescu Street, No. 59, 300239 Timisoara, Romania; (L.M.B.); (N.A.S.); (A.D.C.); (V.N.V.)
- Neurosurgery Department, “Victor Babeş” University of Medicine and Pharmacy, Eftimie Murgu Sq. Nr.2, 300041 Timişoara, Romania
| | - Teodora Hoinoiu
- Department of Clinical Practical Skills, “Victor Babeş” University of Medicine and Pharmacy, Eftimie Murgu Sq. Nr.2, 300041 Timişoara, Romania
- Clinic of Burns, Plastic and Reconstructive Surgery, “Pius Branzeu” Emergency County Hospital, 300041 Timisoara, Romania;
| | - Daciana Grujic
- Clinic of Burns, Plastic and Reconstructive Surgery, “Pius Branzeu” Emergency County Hospital, 300041 Timisoara, Romania;
- Department of Plastic and Reconstructive Surgery, “Victor Babeş” University of Medicine and Pharmacy, Eftimie Murgu Sq. Nr.2, 300041 Timişoara, Romania
| | - Cristina Bredicean
- Department of Psychiatry, “Victor Babeş” University of Medicine and Pharmacy, Eftimie Murgu Sq. Nr.2, 300041 Timişoara, Romania;
| | - Alis Dema
- Morphopathology Department, “Victor Babeş” University of Medicine and Pharmacy, Eftimie Murgu Sq. Nr.2, 300041 Timişoara, Romania; (C.M.O.); (A.D.)
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Arshad R, Barani M, Rahdar A, Sargazi S, Cucchiarini M, Pandey S, Kang M. Multi-Functionalized Nanomaterials and Nanoparticles for Diagnosis and Treatment of Retinoblastoma. BIOSENSORS 2021; 11:97. [PMID: 33810621 PMCID: PMC8066896 DOI: 10.3390/bios11040097] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 12/17/2022]
Abstract
Retinoblastoma is a rare type of cancer, and its treatment, as well as diagnosis, is challenging, owing to mutations in the tumor-suppressor genes and lack of targeted, efficient, cost-effective therapy, exhibiting a significant need for novel approaches to address these concerns. For this purpose, nanotechnology has revolutionized the field of medicine with versatile potential capabilities for both the diagnosis, as well as the treatment, of retinoblastoma via the targeted and controlled delivery of anticancer drugs via binding to the overexpressed retinoblastoma gene. Nanotechnology has also generated massive advancements in the treatment of retinoblastoma based on the use of surface-tailored multi-functionalized nanocarriers; overexpressed receptor-based nanocarriers ligands (folate, galactose, and hyaluronic acid); lipid-based nanocarriers; and metallic nanocarriers. These nanocarriers seem to benchmark in mitigating a plethora of malignant retinoblastoma via targeted delivery at a specified site, resulting in programmed apoptosis in cancer cells. The effectiveness of these nanoplatforms in diagnosing and treating intraocular cancers such as retinoblastoma has not been properly discussed, despite the increasing significance of nanomedicine in cancer management. This article reviewed the recent milestones and future development areas in the field of intraocular drug delivery and diagnostic platforms focused on nanotechnology.
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Affiliation(s)
- Rabia Arshad
- Department of Pharmacy, Quaid-I-Azam University, Islamabad 45320, Pakistan;
| | - Mahmood Barani
- Department of Chemistry, ShahidBahonar University of Kerman, Kerman 76169-14111, Iran;
| | - Abbas Rahdar
- Department of Physics, Faculty of Science, University of Zabol, Zabol 98613-35856, Iran
| | - Saman Sargazi
- Cellular and Molecular Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan 98167-43463, Iran;
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics, Saarland University Medical Center, 66421 Homburg/Saar, Germany;
| | - Sadanand Pandey
- Department of Chemistry, College of Natural Science, Yeungnam University, 280 Daehak-Ro, Gyeongsan 38541, Korea
- Particulate Matter Research Center, Research Institute of Industrial Science & Technology (RIST), 187-12, Geumho-ro, Gwangyang-si 57801, Korea
| | - Misook Kang
- Department of Chemistry, College of Natural Science, Yeungnam University, 280 Daehak-Ro, Gyeongsan 38541, Korea
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16
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Klofas LK, Bogan CM, Coogan AC, Schultenover SJ, Weiss VL, Daniels AB. Instrument Gauge and Type in Uveal Melanoma Fine Needle Biopsy: Implications for Diagnostic Yield and Molecular Prognostication. Am J Ophthalmol 2021; 221:83-90. [PMID: 32818452 PMCID: PMC8117558 DOI: 10.1016/j.ajo.2020.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To systematically evaluate and compare the effects of using small-gauge needles and vitrectors on the ability to obtain adequate diagnostic and prognostic uveal melanoma biopsy specimens. DESIGN Comparative evaluation of biopsy instruments. METHODS Survival of uveal melanoma cells was evaluated in vitro following needle aspiration. Five therapeutically enucleated eyes were sampled in triplicate for ex vivo diagnostic biopsy experiments with 25 gauge (25 G) needle, 27 gauge (27 G) needle, and 27 G vitrector. During surgery in 8 patients, paired diagnostic transscleral fine needle aspiration biopsies were performed using both 25 G and 27 G needles. A review of cytologic specimens was performed by a panel of 3 expert cytopathologists. A retrospective chart review was performed to evaluate 100 consecutive tumors undergoing prognostic biopsy for gene expression profiling to assess the relationship between needle gauge and prognostic adequacy. RESULTS No significant cell shearing of uveal melanoma cells occurred in vitro with 25 G, 27 G, or 30 G needles. For ex vivo biopsy samples, diagnostic yield was 100% using 25 G needle (5/5) or 27 G vitrector (5/5) but 60% using a 27 G needle (3/5). For in vivo samples, no difference in diagnostic yield was found between 25 G (75%, 6/8) or 27 G (75%, 6/8) needle sizes. Of 100 molecular prognostic biopsy samples evaluated, 65 were obtained using 27 G needles; for these biopsies, the prognostic yield was 65/65 (100%). CONCLUSIONS For diagnostic biopsy of uveal melanoma, a larger-gauge needle or a 27 G vitrector may have better overall cellularity and diagnostic yield when compared to a 27 G needle. However, for much more common molecular prognostic testing, a 27 G needle provided adequate sample in 100% (65/65) of cases, and a larger needle provided no additional benefit.
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Affiliation(s)
- Lindsay K Klofas
- Division of Ocular Oncology and Pathology, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA; School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Carley M Bogan
- Division of Ocular Oncology and Pathology, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alice C Coogan
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA; Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephen J Schultenover
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA; Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Vivian L Weiss
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA; Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anthony B Daniels
- Division of Ocular Oncology and Pathology, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA; School of Medicine, Vanderbilt University, Nashville, Tennessee, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Program in Cancer Biology, Vanderbilt University, Nashville, Tennessee, USA.
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17
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Alkatan H, Alyousef N, Alshabib N, J. Aljasser I. A comprehensive review of biopsy techniques for oculoplastic and orbital surgeons from ophthalmic pathologists' perspective. Saudi J Ophthalmol 2021. [DOI: 10.4103/sjopt.sjop_161_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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18
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Liquid Biopsy for Solid Ophthalmic Malignancies: An Updated Review and Perspectives. Cancers (Basel) 2020; 12:cancers12113284. [PMID: 33172021 PMCID: PMC7694640 DOI: 10.3390/cancers12113284] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/29/2020] [Accepted: 11/03/2020] [Indexed: 12/11/2022] Open
Abstract
Simple Summary To date, there is no treatment for metastatic uveal melanoma. Identifying its metastatic spread is essential. Liquid biopsy can identify patients at risk of metastatic spread early. Here, we aim to summarize the current knowledge of liquid biopsy in ophthalmic malignant tumors, including uveal melanoma. Our objective is to establish the current state of liquid biopsy in the ophthalmic field, as well as its perspectives and limitations. Abstract Tissue biopsy is considered the gold standard when establishing a diagnosis of cancer. However, tissue biopsies of intraocular ophthalmic malignancies are hard to collect and are thought to be associated with a non-negligible risk of extraocular dissemination. Recently, the liquid biopsy (LB) has emerged as a viable, non-invasive, repeatable, and promising way of obtaining a diagnosis, prognosis, and theragnosis of patients with solid tumors. LB refers to blood, as well as any human liquid. The natural history of uveal melanoma (UM) and retinoblastoma (RB) are radically opposed. On the one hand, UM is known to disseminate through the bloodstream, and is, therefore, more accessible to systemic venous liquid biopsy. On the other hand, RB rarely disseminates hematogenous, and is, therefore, more accessible to local liquid biopsy by performing an anterior chamber puncture. In this review, we summarize the current knowledge concerning LB in UM, RB, conjunctival tumors, and choroidal metastases. We also develop the current limitations encountered, as well as the perspectives.
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19
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Local and Systemic Management of Uveal Metastasis. Int Ophthalmol Clin 2020; 60:13-26. [PMID: 33093314 DOI: 10.1097/iio.0000000000000332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Polski A, Xu L, Prabakar RK, Kim JW, Shah R, Jubran R, Kuhn P, Cobrinik D, Hicks J, Berry JL. Cell-Free DNA Tumor Fraction in the Aqueous Humor Is Associated With Therapeutic Response in Retinoblastoma Patients. Transl Vis Sci Technol 2020; 9:30. [PMID: 33062393 PMCID: PMC7533735 DOI: 10.1167/tvst.9.10.30] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 08/22/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose The aqueous humor (AH) liquid biopsy enables in vivo evaluation of tumor-derived cell-free DNA (cfDNA) from retinoblastoma (RB) eyes. Herein, we test our hypothesis that longitudinal dynamics of AH cfDNA—including tumor fraction (TFx) and somatic copy number alteration (SCNA) amplitude—correspond to therapeutic response. Methods Eyes with ≥3 AH extractions during intravitreal chemotherapy (IVM) or at secondary enucleation between 2015 to 2019 were included. AH cfDNA was sequenced to assess RB SCNA amplitude; ichorCNA software was used to estimate TFx. Eyes without SCNAs or with TFx < 0.10 across all samples were excluded. Therapeutic responses for each eye were determined from clinical records. Statistical analyses included Mann-Whitney U and Pearson correlation tests. Results Twenty eyes of 20 patients underwent ≥3 AH extractions; 6 eyes lacked SCNAs or had TFx < 0.10 throughout sampling and were excluded. Clinical progression was associated with significantly higher SCNA amplitudes and TFx values than regression (P ≤ 0.04). Relative increases in TFx (ΔTFx 1.86 ± 2.22) were associated with disease progression, whereas relative decreases in TFx (ΔTFx 0.53 ± 0.36) were associated with disease regression (P < 0.00001). A ≥15% increase in TFx relative to baseline during treatment was associated with an over 90-fold increased likelihood of clinical progression (odds ratio = 90.67, 95% confidence interval = 8.30–990.16, P = 0.0002). TFx and SCNA amplitude were significantly positively correlated throughout sampling (P ≤ 0.002). Conclusions Longitudinal changes in AH-derived cfDNA TFx and SCNA amplitude are concordant with clinical responses of intraocular RB during active therapy. Translational Relevance Longitudinal evaluation of AH cfDNA may provide an objective, quantitative way to monitor therapeutic response and disease burden in RB patients.
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Affiliation(s)
- Ashley Polski
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, CA, USA.,USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Liya Xu
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, CA, USA.,Department of Biological Sciences, Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, CA, USA
| | - Rishvanth K Prabakar
- Department of Molecular and Computational Biology, University of Southern California, Los Angeles, CA, USA
| | - Jonathan W Kim
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, CA, USA.,USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Rachana Shah
- Cancer and Blood Disease Institute at Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Rima Jubran
- Cancer and Blood Disease Institute at Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Peter Kuhn
- Department of Biological Sciences, Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, CA, USA.,Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - David Cobrinik
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, CA, USA.,USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.,Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Biochemistry and Molecular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - James Hicks
- Department of Biological Sciences, Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, CA, USA.,Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jesse L Berry
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, CA, USA.,USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.,Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
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21
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Méndez-Martínez S, Santiago Varela M, Blanco-Teijeiro MJ, Piñeiro-Ces A. Diagnosis and long-term monitoring of adenomas of the ciliary body epithelium by ultrasound biomicroscopy. Eur J Ophthalmol 2020; 31:2032-2041. [PMID: 32830591 DOI: 10.1177/1120672120952645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The natural course of adenomas of the ciliary-body epithelium (ACE) is uncertain, due to their low incidence and their frequent initial surgical management.Their differential diagnosis with amelanotic melanoma or metastasis is challenging and diagnostic biopsies require sufficient tissue and highly specialized pathologists. Ultrasound biomicroscopy offers high resolution images and clear sonographic signs suggestive of ACE allowing a more precise differential diagnosis and therefore, a more conservative initial attitude. METHODS Descriptive, retrospective, non-comparative study of consecutive cases of ACE observed between October 2003 and December 2019 in a reference unit in ocular oncology of a tertiary hospital. Patients were studied on a quarterly basis the first year and, subsequently, every 6 months with a complete ophthalmological exam and ultrasound biomicroscopy with the platform Aviso linear scanning 50 MHz probe (Quantel Medical, Clermont-Ferrand, France). RESULTS Three ACE were analysed for a median of 3 years (interquartile range: 2.5-5.5 years). Clinical features include a whitish-to-brown spherical mass, with engorged superficial vessels. Ultrasound biomicroscopy shows an oval-spherical shape, medium-to-high echogenicity, low acoustic attenuation, regular internal structure, and respect for the neighboring structures. By their clinical-ultrasonographic characteristics, one was considered an adenoma of the pigmented ciliary-body epithelium (browner and hyperechogenic) and two were classified as adenomas of the non-pigmented ciliary epithelium (whitish appearance and medium-echogenicity). CONCLUSION Ultrasound biomicroscopy allows a reasonable clinicalsonographic suspicion of ACE. An initial conservative management is proposed as a safer option for stable, mildly symptomatic patients, avoiding aggressive sight threatening treatments.
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Affiliation(s)
| | - María Santiago Varela
- Unidad de Retina Quirúrgica y Tumores Intraoculares del Adulto, Servicio de Oftalmología, Complejo Hospitalario Universitario de Santiago, Área Sanitaria de Santiago de Compostela y Barbanza, SERGAS, Santiago de Compostela, Spain.,Laboratorio de Investigación en Tumores Intraoculares del Adulto, IDIS, Consellería de Sanidade, Xunta de Galicia, Santiago de Compostela, Spain
| | - María José Blanco-Teijeiro
- Unidad de Retina Quirúrgica y Tumores Intraoculares del Adulto, Servicio de Oftalmología, Complejo Hospitalario Universitario de Santiago, Área Sanitaria de Santiago de Compostela y Barbanza, SERGAS, Santiago de Compostela, Spain.,Laboratorio de Investigación en Tumores Intraoculares del Adulto, IDIS, Consellería de Sanidade, Xunta de Galicia, Santiago de Compostela, Spain.,Departamento de Cirugía y Especialidades Médico-Quirúrgicas, Área de Oftalmología, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Antonio Piñeiro-Ces
- Unidad de Retina Quirúrgica y Tumores Intraoculares del Adulto, Servicio de Oftalmología, Complejo Hospitalario Universitario de Santiago, Área Sanitaria de Santiago de Compostela y Barbanza, SERGAS, Santiago de Compostela, Spain.,Laboratorio de Investigación en Tumores Intraoculares del Adulto, IDIS, Consellería de Sanidade, Xunta de Galicia, Santiago de Compostela, Spain.,Departamento de Cirugía y Especialidades Médico-Quirúrgicas, Área de Oftalmología, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
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22
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Xu L, Shen L, Polski A, Prabakar RK, Shah R, Jubran R, Kim JW, Biegel J, Kuhn P, Cobrinik D, Hicks J, Gai X, Berry JL. Simultaneous identification of clinically relevant RB1 mutations and copy number alterations in aqueous humor of retinoblastoma eyes. Ophthalmic Genet 2020; 41:526-532. [PMID: 32799607 DOI: 10.1080/13816810.2020.1799417] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Detection of germline RB1 mutations is critical for risk assessment of retinoblastoma (RB) patients. Assessment of somatic copy number alterations (SCNAs) is also critically important because of their prognostic significance. Herein we present a refined approach for the simultaneous identification of RB1 variants and SCNAs in the aqueous humor (AH) of RB eyes. MATERIALS AND METHODS Subjects included 7 eyes of 6 RB patients that underwent AH extraction, and 4 matched tumor samples. Cell-free DNA (cfDNA) was isolated and sequenced to assess genome-wide SCNAs. The same sequencing libraries then underwent targeted resequencing and mutation detection using a custom hybridization panel that targets RB1 and MYCN. Illumina paired-end 2x150bp sequencing was used to characterize single-nucleotide variants (SNVs) and loss of heterozygosity (LOH). Results were compared to peripheral blood RB1 testing. Tumor fraction (TFx) was calculated using ichorCNA. RESULTS Four of 7 AH samples contained clinically significant SCNAs. Of the 3 other samples, 1 showed focal MYCN amplification and 1 showed focal RB1 deletion. All 4 enucleated tumors contained SCNAs. Mutational analysis of tumor DNA identified all first hits (2 germline RB1 SNVs, 2 germline CNAs) and second hits (4 RB1 SNVs). RB1 variants in AH were concordant with those obtained from corresponding tumor tissue and blood. In AH samples without paired tumor, both RB1 hits were identified with high variant allele frequency, even in the absence of SCNAs. CONCLUSIONS AH liquid biopsy is a minimally invasive, in vivo alternative to tissue analysis for the simultaneous identification of RB1 variants and SCNAs in RB eyes.
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Affiliation(s)
- Liya Xu
- The Vision Center, Children's Hospital Los Angeles , Los Angeles, California, USA.,Department of Biological Sciences, Dornsife College of Letters, Arts, and Sciences, University of Southern California , Los Angeles, California, USA
| | - Lishuang Shen
- Center for Personalized Medicine, Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles , Los Angeles, California, USA
| | - Ashley Polski
- The Vision Center, Children's Hospital Los Angeles , Los Angeles, California, USA.,USC Roski Eye Institute, Keck School of Medicine of USC , Los Angeles, California, USA
| | - Rishvanth K Prabakar
- Department of Molecular and Computational Biology, University of Southern California , Los Angeles, California, USA
| | - Rachana Shah
- Center for Blood Disorders, Children's Hospital Los Angeles , Los Angeles, California, USA
| | - Rima Jubran
- Center for Blood Disorders, Children's Hospital Los Angeles , Los Angeles, California, USA
| | - Jonathan W Kim
- The Vision Center, Children's Hospital Los Angeles , Los Angeles, California, USA.,USC Roski Eye Institute, Keck School of Medicine of USC , Los Angeles, California, USA
| | - Jacklyn Biegel
- Center for Personalized Medicine, Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles , Los Angeles, California, USA
| | - Peter Kuhn
- Department of Biological Sciences, Dornsife College of Letters, Arts, and Sciences, University of Southern California , Los Angeles, California, USA.,Norris Comprehensive Cancer Center, Keck School of Medicine of USC , Los Angeles, California, USA.,Department of Aerospace and Mechanical Engineering, Viterbi School of Engineering, University of Southern California , Los Angeles, California, USA.,Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California , Los Angeles, California, USA
| | - David Cobrinik
- The Vision Center, Children's Hospital Los Angeles , Los Angeles, California, USA.,USC Roski Eye Institute, Keck School of Medicine of USC , Los Angeles, California, USA.,Norris Comprehensive Cancer Center, Keck School of Medicine of USC , Los Angeles, California, USA.,The Saban Research Institute, Children's Hospital Los Angeles , Los Angeles, California, USA
| | - James Hicks
- Department of Biological Sciences, Dornsife College of Letters, Arts, and Sciences, University of Southern California , Los Angeles, California, USA.,Norris Comprehensive Cancer Center, Keck School of Medicine of USC , Los Angeles, California, USA.,Department of Biochemistry and Molecular Medicine, Keck School of Medicine of USC , Los Angeles, California, USA
| | - Xiaowu Gai
- Center for Personalized Medicine, Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles , Los Angeles, California, USA
| | - Jesse L Berry
- The Vision Center, Children's Hospital Los Angeles , Los Angeles, California, USA.,USC Roski Eye Institute, Keck School of Medicine of USC , Los Angeles, California, USA.,Norris Comprehensive Cancer Center, Keck School of Medicine of USC , Los Angeles, California, USA.,The Saban Research Institute, Children's Hospital Los Angeles , Los Angeles, California, USA
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Xu L, Polski A, Prabakar RK, Reid MW, Chevez-Barrios P, Jubran R, Kim JW, Kuhn P, Cobrinik D, Hicks J, Berry JL. Chromosome 6p Amplification in Aqueous Humor Cell-Free DNA Is a Prognostic Biomarker for Retinoblastoma Ocular Survival. Mol Cancer Res 2020; 18:1166-1175. [PMID: 32434859 PMCID: PMC7415535 DOI: 10.1158/1541-7786.mcr-19-1262] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/10/2020] [Accepted: 05/18/2020] [Indexed: 11/16/2022]
Abstract
Aqueous humor contains tumor-derived cell-free DNA (cfDNA) and can serve as a liquid biopsy for retinoblastoma. We previously associated somatic copy-number alteration (SCNA) 6p gain with a 10-fold increased risk of enucleation. Here we provide a 2-year update to further explore 6p gain as a prognostic biomarker for ocular survival. Patients diagnosed with retinoblastoma from December 2014 to July 2019 from whom aqueous humor was sampled were included. cfDNA was extracted and shallow whole-genome sequencing performed to identify highly recurrent retinoblastoma SCNAs (gain of 1q, 2p, 6p, loss of 13q, 16q). 116 aqueous humor samples from 50 eyes of 46 patients were included: 27 eyes were salvaged, 23 were enucleated. Highly recurrent retinoblastoma SCNAs were found in 66% eyes. 6p gain was the most prevalent SCNA (50% eyes). It was particularly more prevalent in enucleated eyes (73.9%) than in salvaged eyes (29.6%; P = 0.004). 6p gain in aqueous humor cfDNA portended nearly 10-fold increased odds of enucleation (OR = 9.87; 95% confidence interval = 1.75-55.65; P = 0.009). In the enucleated eyes, 6p gain was associated with aggressive histopathologic features, including necrosis, higher degrees of anaplasia, and focal invasion of ocular structures. With extended follow-up and nearly double the aqueous humor samples, we continue to demonstrate 6p gain as a potential prognostic biomarker for retinoblastoma. IMPLICATIONS: Aqueous humor is a high-yield source of tumor-derived DNA in retinoblastoma eyes. Detection of 6p gain in the aqueous humor allows for targeted, patient-centered therapies based on this molecular prognostic marker. Prospective, multicenter studies with aqueous humor sampled from all eyes at diagnosis are warranted to validate these findings.
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Affiliation(s)
- Liya Xu
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California
- Department of Biological Sciences, Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, California
- The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California
| | - Ashley Polski
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California
- USC Roski Eye Institute, Keck Medical School of the University of Southern California, Los Angeles, California
| | - Rishvanth K Prabakar
- Department of Molecular and Computational Biology, University of Southern California, Los Angeles, California
| | - Mark W Reid
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California
| | - Patricia Chevez-Barrios
- Departments of Pathology and Genomic Medicine and Ophthalmology, Houston Methodist, Weill Cornell Medical College, Houston, Texas
| | - Rima Jubran
- Department of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California
| | - Jonathan W Kim
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California
- USC Roski Eye Institute, Keck Medical School of the University of Southern California, Los Angeles, California
| | - Peter Kuhn
- Department of Biological Sciences, Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, California
- The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
- Department of Aerospace and Mechanical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California
| | - David Cobrinik
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California
- The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California
- USC Roski Eye Institute, Keck Medical School of the University of Southern California, Los Angeles, California
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
- Department of Biochemistry and Molecular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - James Hicks
- Department of Biological Sciences, Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, California
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jesse L Berry
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California.
- The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California
- USC Roski Eye Institute, Keck Medical School of the University of Southern California, Los Angeles, California
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
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24
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Bellerive C, Biscotti CV, Singh N, Singh AD. Fine-needle aspiration biopsy for suspected uveal metastases. Can J Ophthalmol 2019; 54:694-698. [PMID: 31836102 DOI: 10.1016/j.jcjo.2019.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE One indication of fine-needle aspiration biopsy (FNAB) is the diagnostic confirmatory of a clinical suspicion of uveal metastasis. We analyzed our experience in this clinical setting to assess the effectiveness of FNAB technique. DESIGN Retrospective study. PARTICIPANTS 28 patients (28 eyes) underwent FNAB biopsy. METHODS Aspirates were performed using 25-gauge needle and were classified into the following categories: positive, atypical, negative, or nondiagnostic. The electronic medical records provided all clinical data. Subsequent clinical course was considered as the diagnostic standard. RESULTS Subsequent clinical course was metastatic tumour in 19 cases (68%) and nonmetastatic tumour in other 9 cases, considered as the diagnostic standard. Cytological interpretations for metastases were positive in 19 cases (68%), atypical in 2 cases (7%), negative in 4 cases (14%), and nondiagnostic in 3 cases (11%). The metastasis-positive cases included 9 adenocarcinoma, 3 uveal lymphoma, 3 small cell carcinomas, 3 non-small cell carcinomas, and 1 metastatic paraganglioma. Both of the atypical cases were suggestive for non-Hodgkin lymphoma. The 4 negative cases for metastases included 2 true negative cases, and 2 false negative aspirates that subsequently proved to be metastatic adenocarcinoma. The 3 nondiagnostic cases included 1 schwannoma, 1 low-grade uveal non-Hodgkin lymphoma, and 1 metastatic adenocarcinoma. The overall sensitivity for FNAB was 87.5%, with a specificity of 100%. CONCLUSIONS FNAB of suspected uveal metastases is a reliable diagnostic technique.
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Affiliation(s)
- Claudine Bellerive
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, OH; Centre Universitaire d'Ophtalmologie, Centre Hospitalier de Quebec, Quebec, Ont..
| | - Charles V Biscotti
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, OH
| | - Nakul Singh
- Case Western Reserve University, Cleveland, OH
| | - Arun D Singh
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, OH
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25
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26
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Corrêa ZM, Augsburger JJ. Indications for Fine Needle Aspiration Biopsy of Posterior Segment Intraocular Tumors. Am J Ophthalmol 2019; 207:45-61. [PMID: 31170388 DOI: 10.1016/j.ajo.2019.05.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/13/2019] [Accepted: 05/28/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE To define 4 indication categories of fine needle aspiration biopsies (FNABs) of solid intraocular tumors and describe the differences among the patients, tumors, and results of biopsy in these 4 indication categories. METHODS Retrospective descriptive analysis of 880 FNABs of a solid intraocular tumor of the posterior ocular segment performed by in the authors' ocular oncology practice during the period July 1980 through July 2014. RESULTS FNABs were performed as a separate procedure in 372 cases (42.3%), at plaque implantation in 279 (31.7%), post-enucleation in 225 (25.6%), and post-resection/pre-laser in 4 (0.4%). FNABs were categorized as diagnostic in 292 (33.2%), confirmatory in 121 (13.8%), investigational in 187 (21.3%), and prognostic in 280 (31.8%). Prior to the biopsy, all patients who underwent diagnostic FNAB had a tumor of uncertain pathologic type, while all patients who underwent confirmatory FNAB had a clinically diagnosed malignant intraocular neoplasm. In contrast, all patients who underwent a prognostic FNAB had an unequivocal primary posterior uveal melanoma clinically, while patients who underwent an investigational biopsy all had an unequivocal or probable malignant intraocular tumor of a specific type. Most diagnostic FNABs were performed transvitreously (n = 255, 87.3%) compared to prognostic FNABs (n = 143, 51.1%) (P < .001). Overall, 733 FNABs (83.3%) yielded a sufficient specimen for cytologic diagnosis. Diagnostic and confirmatory FNABs were the most likely to yield an insufficient aspirate (28.4% and 20.7%, respectively), while investigational and prognostic FNABs were most likely to yield sufficient specimens (94.7% and 90.0%, respectively) (P < .001). Mean post-FNAB follow-up of the entire group was 62.7 months (standard deviation [SD] = 59.8, 95% confidence interval [CI] = 58.7-66.6). Mean posttreatment follow-up or total follow-up of untreated patients was 53.7 months (SD = 58.7, 95% CI = 49.8-57.6). CONCLUSIONS Because of the substantial differences shown among FNAB cases performed for different indications, it seems appropriate to report results of FNAB or other biopsy methods according to the category (indication) of the biopsy. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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27
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Intraocular Biopsy and ImmunoMolecular Pathology for "Unmasking" Intraocular Inflammatory Diseases. J Clin Med 2019; 8:jcm8101733. [PMID: 31635036 PMCID: PMC6832563 DOI: 10.3390/jcm8101733] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/05/2019] [Accepted: 10/15/2019] [Indexed: 12/15/2022] Open
Abstract
Intraocular inflammation can hide a variety of eye pathologies. In 33% of cases, to obtain a correct diagnosis, investigation of the intraocular sample is necessary. The combined analyses of the intraocular biopsy, using immuno-pathology and molecular biology, point to resolve the diagnostic dilemmas in those cases where history, clinical tests, and ophthalmic and systemic examinations are inconclusive. In such situations, the teamwork between the ophthalmologist and the molecular pathologist is critically important to discriminate between autoimmune diseases, infections, and intraocular tumors, including lymphoma and metastases, especially in those clinical settings known as masquerade syndromes. This comprehensive review focuses on the diagnostic use of intraocular biopsy and highlights its potential to enhance research in the field. It describes the different surgical techniques of obtaining the biopsy, risks, and complication rates. The review is organized according to the anatomical site of the sample: I. anterior chamber containing aqueous humor, II. iris and ciliary body, III. vitreous, and IV. choroid and retina. We have excluded the literature concerning biopsy for choroidal melanoma and retinoblastoma, as this is a specialized area more relevant to ocular oncology.
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Shi H, Zhou X, Chen B, Xiao J, Li Y, Zhou X, Zhou Q, Chen K, Wang Q. Clinical Relevance of the High Prevalence of MYD88 L265P Mutated Vitreoretinal Lymphoma Identified by Droplet Digital Polymerase Chain Reaction. Ocul Immunol Inflamm 2019; 29:448-455. [PMID: 31603365 DOI: 10.1080/09273948.2019.1657903] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose: To investigate the frequency and clinical relevance of missense mutation at position 265 changing leucine to proline in the myeloid differentiation factor 88 gene (MYD88 L265P) in the vitreous of Chinese patients with vitreoretinal lymphoma (VRL) using droplet digital polymerase chain reaction (ddPCR).Methods: Vitreous fluid (VF) from 29 eyes of 20 VRL patients at the North Huashan Hospital were included. MYD88 L265P analysis of VF was performed using ddPCR. Associations between clinicopathologic characteristics and MYD88 mutation were analyzed using t-test or Fisher's exact test.Results: MYD88 L265P mutations were detected in 22 of 29 samples from 14 patients with diffuse large B-cell lymphomas and one patient with lymphoplasmacytoid lymphoma. However, no significant associations were found between MYD88 L265P mutation status and age, sex, lymphoma subtype or location of the primary lesion.Conclusion: The high prevalence of MYD88 L265P identified by ddPCR suggests that this method of evaluating the frequency of MYD88 L265P is a promising tool for accurate diagnosis of VRL.
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Affiliation(s)
- Huimin Shi
- Department of Ophthalmology, North Huashan Hospital, Fudan University, Shanghai, China
| | - Xian Zhou
- Department of Ophthalmology, Huashan Hospital, Fudan University, Shanghai, China
| | - Bobin Chen
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianjiang Xiao
- Department of Ophthalmology, North Huashan Hospital, Fudan University, Shanghai, China
| | - Yi Li
- Department of Ophthalmology, North Huashan Hospital, Fudan University, Shanghai, China
| | - Xianjin Zhou
- Department of Ophthalmology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiang Zhou
- Department of Ophthalmology, North Huashan Hospital, Fudan University, Shanghai, China
| | - Kun Chen
- Department of Laboratory Medicine, North Huashan Hospital, Fudan University, Shanghai, China
| | - Qingping Wang
- Department of Ophthalmology, Huashan Hospital, Fudan University, Shanghai, China
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29
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Frizziero L, Midena E, Trainiti S, Londei D, Bonaldi L, Bini S, Parrozzani R. Uveal Melanoma Biopsy: A Review. Cancers (Basel) 2019; 11:cancers11081075. [PMID: 31366043 PMCID: PMC6721328 DOI: 10.3390/cancers11081075] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/18/2019] [Accepted: 07/25/2019] [Indexed: 12/11/2022] Open
Abstract
Intraocular tumor diagnosis is based on clinical findings supported by additional imaging tools, such as ultrasound, optical coherence tomography and angiographic techniques, usually without the need for invasive procedures or tissue sampling. Despite improvements in the local treatment of uveal melanoma (UM), the prevention and treatment of the metastatic disease remain unsolved, and nearly 50% of patients develop liver metastasis. The current model suggests that tumor cells have already spread by the time of diagnosis, remaining dormant until there are favorable conditions. Tumor sampling procedures at the time of primary tumor diagnosis/treatment are therefore now commonly performed, usually not to confirm the diagnosis of UM, but to obtain a tissue sample for prognostication, to assess patient's specific metastatic risk. Moreover, several studies are ongoing to identify genes specific to UM tumorigenesis, leading to several potential targeted therapeutic strategies. Genetic information can also influence the surveillance timing and metastatic screening type of patients affected by UM. In spite of the widespread use of biopsies in general surgical practice, in ophthalmic oncology the indications and contraindications for tumor biopsy continue to be under debate. The purpose of this review paper is to critically evaluate the role of uveal melanoma biopsy in ophthalmic oncology.
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Affiliation(s)
- Luisa Frizziero
- IRCCS-Istituto di Ricovero e Cura a Carattere Scientifico-Fondazione Bietti, 00198 Rome, Italy
| | - Edoardo Midena
- IRCCS-Istituto di Ricovero e Cura a Carattere Scientifico-Fondazione Bietti, 00198 Rome, Italy.
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy.
| | - Sara Trainiti
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy
| | - Davide Londei
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy
| | - Laura Bonaldi
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS - Istituto di Ricovero e Cura a Carattere Scientifico, 35128 Padova, Italy
| | - Silvia Bini
- IRCCS-Istituto di Ricovero e Cura a Carattere Scientifico-Fondazione Bietti, 00198 Rome, Italy
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Ghiam BK, Xu L, Berry JL. Aqueous Humor Markers in Retinoblastoma, a Review. Transl Vis Sci Technol 2019; 8:13. [PMID: 31019846 PMCID: PMC6469575 DOI: 10.1167/tvst.8.2.13] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 01/01/2019] [Indexed: 12/11/2022] Open
Abstract
Purpose Retinoblastoma (Rb) is the most common primary intraocular cancer in children. Unlike with most solid tumors, direct biopsy is contraindicated due to risk of tumor dissemination. However, recent therapeutic techniques have allowed for the safe extraction of aqueous humor (AH) from eyes undergoing therapy, providing the unique opportunity to use AH as a liquid biopsy for Rb. Although the extraction of AH in Rb eyes undergoing therapy is new, the consideration of whether there are tumor biomarkers in the AH is not. The current manuscript is a systematic review of all studies that have examined biomarkers in the AH of Rb eyes. The authors hypothesized that AH sampling and analysis of tumor biomarkers may have new clinical relevance for the diagnosis, prognosis, and/or management of Rb. Methods A comprehensive database search (PubMed, Web of Science, Embase, and Cochrane Databases) was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to identify articles on AH markers in Rb eyes. Inclusion criteria included English language articles with original reports on AH markers in the eyes of patients with confirmed Rb. Data on marker type, number of eyes, marker means and ranges, and when available, control values and clinicopathological correlations were collected. Articles were stratified based on marker type, and assessed quantitatively and qualitatively. Results An initial database search produced 325 articles, and an additional 11 articles were identified through searching citations. After removing duplicates and applying the eligibility criteria, we selected 27 articles to be included in the current review. A total of 463 eyes with histologically confirmed Rb were included in this review. The various markers and their values, with comparison to controls and clinicopathological correlations, are discussed. Conclusions AH sampling and tumor biomarker analysis in eyes without undergoing enucleation have the potential to revolutionize the management of Rb. Translational Relevance Although previous studies evaluated markers in the AH only after enucleation and not at diagnosis or during therapy, the clinical relevance of these markers was limited. However, recent changes in the management of Rb have allowed for safe sampling of the aqueous during therapy and, thus, correlation of tumor biomarkers with disease course. Thus, the authors felt it important to revisit previous research to evaluate whether these markers may now be applicable for the diagnosis, prognosis, or management of Rb
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Affiliation(s)
- Benjamin K Ghiam
- Oakland University, William Beaumont School of Medicine, Rochester, MI, USA
| | - Liya Xu
- Department of Biological Sciences, Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, CA, USA
| | - Jesse L Berry
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, CA, USA.,USC Roski Eye Institute, Keck School of Medicine of USC, University of Southern California (USC), Los Angeles, CA, USA
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31
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Le Guin CHD, Metz KA, Lehmann N, Kreis SH, Bornfeld N, Rudolf Lohmann D, Zeschnigk M. Chromosome 3 is a valid marker for prognostic testing of biopsy material from uveal melanoma later treated by brachytherapy. Biomarkers 2018; 24:134-140. [DOI: 10.1080/1354750x.2018.1517827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Claudia Helga Dorothee Le Guin
- Department of Ophthalmology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Eye Oncogenetic Research Group, Institute of Human Genetics, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Klaus Alfred Metz
- Institute of Pathology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Nils Lehmann
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Stefan Horst Kreis
- Department of Ophthalmology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Norbert Bornfeld
- Department of Ophthalmology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Dietmar Rudolf Lohmann
- Institute of Human Genetics, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Eye Oncogenetic Research Group, Institute of Human Genetics, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Michael Zeschnigk
- Institute of Human Genetics, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Eye Oncogenetic Research Group, Institute of Human Genetics, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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Mathis T, Jardel P, Loria O, Delaunay B, Nguyen AM, Lanza F, Mosci C, Caujolle JP, Kodjikian L, Thariat J. New concepts in the diagnosis and management of choroidal metastases. Prog Retin Eye Res 2018; 68:144-176. [PMID: 30240895 DOI: 10.1016/j.preteyeres.2018.09.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 09/04/2018] [Accepted: 09/07/2018] [Indexed: 12/17/2022]
Abstract
The most frequent site of ocular metastasis is the choroid. The occurrence of choroidal metastases has increased steadily due to the longer survival of metastatic patients and the improvement of diagnostic tools. Fundoscopy, ultrasonography, and fluorescein angiography are now complemented by indocyanine green angiography and optical coherence tomography. Choroidal tumor biopsy may also confirm the metastatic nature of the tumor and help to determine the site of the primary malignancy. There is currently no consensus on the treatment strategy. Most patients have a limited life expectancy and for these complex treatments are generally not recommended. However, recent advances in systemic therapy have significantly improved survival of certain patients who may benefit from an aggressive ocular approach that could preserve vision. Although external beam radiation therapy is the most widely used treatment, more advanced forms of radiotherapy that are associated with fewer side effects can be proposed in select cases. In patients with a shorter life expectancy, systemic therapies such as those targeting oncogenic drivers, or immunotherapy can induce a regression of the choroidal metastases, and may be sufficient to temporarily decrease visual symptoms. However, they often acquire resistance to systemic treatment and ocular relapse usually requires radiotherapy for durable control. Less invasive office-based treatments, such as photodynamic therapy and intravitreal injection of anti-VEGF, may also help to preserve vision while reducing time spent in medical settings for patients in palliative care. The aim of this review is to summarize the current knowledge on choroidal metastases, with emphasis on the most recent findings in epidemiology, pathogenesis, diagnosis and treatment.
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Affiliation(s)
- Thibaud Mathis
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France; UMR-CNRS 5510 Matéis, 69100, Villeurbane, France
| | - Pauline Jardel
- Department of Radiation Oncology, Chicoutimi Hospital, Saguenay, QC, Canada
| | - Olivier Loria
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France
| | - Benoit Delaunay
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France
| | - Anh-Minh Nguyen
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France
| | - Francesco Lanza
- Department of Ophthalmology, Ocular Oncology Center, E.O. Ospedali Galliera, Genoa, Italy
| | - Carlo Mosci
- Department of Ophthalmology, Ocular Oncology Center, E.O. Ospedali Galliera, Genoa, Italy
| | | | - Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France; UMR-CNRS 5510 Matéis, 69100, Villeurbane, France
| | - Juliette Thariat
- Department of Radiation Therapy, Centre François Baclesse - ARCHADE, Unicaen - Normandie University, 14000, Caen, France.
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Bagger MM. Intraocular biopsy of uveal melanoma Risk assessment and identification of genetic prognostic markers. Acta Ophthalmol 2018; 96 Suppl A112:1-28. [PMID: 30133961 DOI: 10.1111/aos.13858] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Mette Marie Bagger
- Departments of Clinical Genetics and Ophthalmology; Rigshospitalet Blegdamsvej; Copenhagen University Hospital; Copenhagen Denmark
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34
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Venkatesh P, Kashyap S, Temkar S, Gogia V, Garg G, Bafna RK. Endoillumination (chandelier) and wide-angle viewing-assisted fine-needle aspiration biopsy of intraocular mass lesions. Indian J Ophthalmol 2018; 66:845-847. [PMID: 29785997 PMCID: PMC5989511 DOI: 10.4103/ijo.ijo_1306_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/20/2018] [Indexed: 11/04/2022] Open
Abstract
Fine-needle aspiration biopsy (FNAB) of intraocular mass lesions is an important intervention in the presence of diagnostic difficulty. FNAB of intraocular mass lesions is also likely to become more commonly recommended for prognostication of tumors such as choroidal melanoma. The most commonly described approach for tumor localization and visualization during FNAB is transillumination and indirect ophthalmoscopic viewing. Herein, we report endoillumination (chandelier) and wide-angle viewing assisted, microscope-based approach for FNAB in two patients using two port minimally invasive vitreoretinal surgical approach. The submission is supported by a video demonstration. The entire procedure was completed under the microscope. Adequate sample was obtained. In the first patient, the inflammatory nature of the lesion was confirmed though magnetic resonance imaging had been reported as melanoma. In the second patient, a clinical diagnosis of amelanotic melanoma was confirmed. Endoillumination-assisted FNAB of intraocular mass lesions is easier to learn and more precise and hence carries lesser risks.
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Affiliation(s)
- Pradeep Venkatesh
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Kashyap
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Shreyas Temkar
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Varun Gogia
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Gaurav Garg
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Kumar Bafna
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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35
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Berry JL, Xu L, Murphree AL, Krishnan S, Stachelek K, Zolfaghari E, McGovern K, Lee TC, Carlsson A, Kuhn P, Kim JW, Cobrinik D, Hicks J. Potential of Aqueous Humor as a Surrogate Tumor Biopsy for Retinoblastoma. JAMA Ophthalmol 2017; 135:1221-1230. [PMID: 29049475 DOI: 10.1001/jamaophthalmol.2017.4097] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Retinoblastoma (Rb) is one of the first tumors to have a known genetic etiology. However, because biopsy of this tumor is contraindicated, it has not been possible to define the effects of secondary genetic changes on the disease course. Objective To investigate whether the aqueous humor (AH) of Rb eyes has sufficient tumor-derived DNA to perform genetic analysis of the tumor, including DNA copy number alterations. Design, Setting, and Participants This investigation was a case series study at a tertiary care hospital (Children's Hospital Los Angeles) with a large Rb treatment center. Cell-free DNA (cfDNA) was isolated from 6 AH samples from 3 children with Rb, including 2 after primary enucleation and 1 undergoing multiple intravitreous injections of melphalan for vitreous seeding. Samples were taken between December 2014 and September 2015. Main Outcomes and Measures Measurable levels of nucleic acids in the AH and identification of tumor-derived DNA copy number variation in the AH. The AH was analyzed for DNA, RNA, and micro-RNA using Qubit high-sensitivity kits. Cell-free DNA was isolated from the AH, and sequencing library protocols were optimized. Shallow whole-genome sequencing was performed on an Illumina platform, followed by genome-wide chromosomal copy number variation profiling to assess the presence of tumor DNA fractions in the AH cfDNA of the 3 patients. One child's cfDNA from the AH and tumor DNA were subjected to Sanger sequencing to isolate the RB1 mutation. Results Six AH samples were obtained from 3 Rb eyes in 3 children (2 male and 1 female; diagnosed at ages 7, 20, and 28 months). A corroborative pattern between the chromosomal copy number variation profiles of the AH cfDNA and tumor-derived DNA from the enucleated samples was identified. In addition, a nonsense RB1 mutation (Lys→STOP) from 1 child was also identified from the AH samples obtained during intravitreous injection of melphalan, which matched the tumor sample postsecondary enucleation. Sanger sequencing of the AH cfDNA and tumor DNA with polymerase chain reaction primers targeting RB1 gene c.1075A demonstrated this same RB1 mutation. Conclusions and Relevance In this study evaluating nucleic acids in the AH from Rb eyes undergoing salvage therapy with intravitreous injection of melphalan, the results suggest that the AH can serve as a surrogate tumor biopsy when Rb tumor tissue is not available. This novel method will allow for analyses of tumor-derived DNA in Rb eyes undergoing salvage therapy that have not been enucleated.
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Affiliation(s)
- Jesse L Berry
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California.,USC Roski Eye Institute, Keck School of Medicine of USC, University of Southern California (USC), Los Angeles
| | - Liya Xu
- Department of Biological Sciences, USC Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles
| | - A Linn Murphree
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California.,USC Roski Eye Institute, Keck School of Medicine of USC, University of Southern California (USC), Los Angeles
| | | | - Kevin Stachelek
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California
| | - Emily Zolfaghari
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California.,USC Roski Eye Institute, Keck School of Medicine of USC, University of Southern California (USC), Los Angeles
| | - Kathleen McGovern
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California
| | - Thomas C Lee
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California.,USC Roski Eye Institute, Keck School of Medicine of USC, University of Southern California (USC), Los Angeles
| | - Anders Carlsson
- Department of Biological Sciences, USC Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles
| | - Peter Kuhn
- Department of Biological Sciences, USC Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles.,Norris Comprehensive Cancer Center, Keck School of Medicine of USC, University of Southern California, Los Angeles.,Department of Aerospace and Mechanical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles.,Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles
| | - Jonathan W Kim
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California.,USC Roski Eye Institute, Keck School of Medicine of USC, University of Southern California (USC), Los Angeles
| | - David Cobrinik
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California.,USC Roski Eye Institute, Keck School of Medicine of USC, University of Southern California (USC), Los Angeles.,Norris Comprehensive Cancer Center, Keck School of Medicine of USC, University of Southern California, Los Angeles.,Department of Biochemistry and Molecular Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles.,The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California
| | - James Hicks
- Department of Biological Sciences, USC Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles.,Norris Comprehensive Cancer Center, Keck School of Medicine of USC, University of Southern California, Los Angeles
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36
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Tura A, Merz H, Reinsberg M, Lüke M, Jager MJ, Grisanti S, Lüke J. Analysis of monosomy-3 in immunomagnetically isolated circulating melanoma cells in uveal melanoma patients. Pigment Cell Melanoma Res 2017; 29:583-9. [PMID: 27390171 DOI: 10.1111/pcmr.12507] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 06/28/2016] [Indexed: 12/22/2022]
Abstract
Monosomy-3 in primary uveal melanoma (UM) is associated with a high risk of metastasis and mortality. Although circulating melanoma cells (CMC) can be found in most UM patients, only approximately 50% of the patients develop metastases. We utilized a novel immuno-FISH assay to detect chromosome-3 in intact CMC isolated by dual immunomagnetic enrichment. Circulating melanoma cells were detected in 91% of the patients (n = 44) with primary non-metastatic UM, of which 58% were positive for monosomy-3. The monosomy-3 status of CMC corresponded to the monosomy-3 status of the primary tumor in 10 of the 11 patients where this could be tested. Monosomy-3 in the CMC was associated with an advanced tumor stage (P = 0.046) and was detected in all four patients who developed metastasis within the follow-up period of 4 yr. This non-invasive technique may enable the identification of UM patients at risk for metastasis particularly when a primary tumor specimen is unavailable.
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Affiliation(s)
- Aysegül Tura
- Department of Ophthalmology, University of Lübeck, Lübeck, Germany.
| | - Hartmut Merz
- Department of Pathology, University of Lübeck, Lübeck, Germany
| | | | - Matthias Lüke
- Department of Ophthalmology, University of Lübeck, Lübeck, Germany
| | - Martine J Jager
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Julia Lüke
- Department of Ophthalmology, University of Lübeck, Lübeck, Germany
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Reddy DM, Mason LB, Mason JO, Crosson JN, Yunker JJ. Vitrectomy and Vitrector Port Needle Biopsy of Choroidal Melanoma for Gene Expression Profile Testing Immediately before Brachytherapy. Ophthalmology 2017; 124:1377-1382. [DOI: 10.1016/j.ophtha.2017.03.053] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 03/11/2017] [Accepted: 03/29/2017] [Indexed: 11/26/2022] Open
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Retrospective Study of Vitreous Tap Technique Using Needle Aspiration for Management of Shallow Anterior Chamber during Phacoemulsification. J Ophthalmol 2017; 2017:2801025. [PMID: 28607771 PMCID: PMC5451757 DOI: 10.1155/2017/2801025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/23/2017] [Accepted: 03/06/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose To evaluate the technique of vitreous tap using needle aspiration for management of anterior chamber shallowness during phacoemulsification. Methods A retrospective study included 26 eyes of 17 patients who underwent phacoemulsification in which vitreous tap was performed using a 27-gauge needle attached to a 5 ml syringe, inserted 3.5 mm from the limbus to aspirate 0.2 ml of liquefied vitreous if a cohesive (OVD) failed to sufficiently deepen the anterior chamber. Results Preoperative anterior chamber depth was 2.31 ± 0.26 mm, axial length was 21.7 ± 0.67 mm, lens thickness was 4.5 ± .19 mm, and cataract grade was 3.77 ± 1.4. Preoperative CDVA in LogMAR units was 0.98 ± 0.75. Coexisting angle closure glaucoma was present in 7 patients (26.92%) preoperatively. Vitreous needle tap was successful in vitreous removal on the first attempt in 26 eyes (100%). Postoperative follow-up period was 22.88 ± 10.24 (4–39) months. The final postoperative CDVA in LogMAR units was 0.07 ± 0.1, while the final postoperative IOP was 16.54 ± 1.45 mmHg. No complications related to vitreous tap were noted. Conclusion Vitreous needle tap is a simple, cost-effective, and safe technique for management of shallow anterior chamber in phacoemulsification.
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Konstantinidis L, Damato B. Intraocular Metastases--A Review. Asia Pac J Ophthalmol (Phila) 2017; 6:208-214. [PMID: 28399345 DOI: 10.22608/apo.201712] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 03/29/2017] [Indexed: 11/08/2022] Open
Abstract
Intraocular metastases almost invariably arise in the uveal tract, mostly in the posterior choroid. They are the most common type of intraocular malignancy and often the first sign of tumor dissemination. Choroidal metastases generally appear as a creamy white or pale yellow mass associated with subretinal fluid and may be multifocal and bilateral. The most common primary sites are breast and lung. Diagnosis is aided by a variety of tests, particularly ultrasonography and optical coherence tomography. Intraocular biopsy is useful in patients with clinical suspicion of uveal metastasis but no evidence of primary malignancy despite systemic evaluation. If systemic treatment fails to control the ocular tumor, a good response is usually achieved with local therapies such as external beam radiation therapy, photodynamic therapy, and transpupillary thermotherapy. The life expectancy of patients with choroidal metastases is generally poor but has been improving thanks to the therapeutic advances taking place.
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Affiliation(s)
| | - Bertil Damato
- Ocular Oncology Service, University of California, San Francisco, San Francisco, California
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40
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Mahdjoubi A, Cassoux N, Levy-Gabriel C, Desjardins L, Klos J, Caly M, Vlajnic T, Gardrat S, Klijanienko J. Adult ocular medulloepithelioma diagnosed by transscleral fine needle aspiration: A case report. Diagn Cytopathol 2017; 45:561-564. [PMID: 28217870 DOI: 10.1002/dc.23694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 01/20/2017] [Accepted: 02/08/2017] [Indexed: 11/10/2022]
Abstract
Ocular medulloepithelioma (ME) is a rare congenital tumor which occurs usually during childhood but is also reported in adults. They have seen an intraocular tumor in an 89 years-old female with a history of small cell lung carcinoma. Transscleral fine needle aspiration was performed. Aspirates were rich and composed of two distinctive populations of cells. The first consisted of epithelioid large cohesive cells with rare rosettes. Nuclei were oval and chromatin was delicate with small nucleoli. The second population consisted of smaller and dispersed cells with regular nuclei and dusty chromatin. Immunohistochemistry performed on paraffin-embedded cell block sections showed that the larger cells and rosettes were cytokeratin AE1/AE3, Synaptophysin, Chromogranin A, CD56, NSE, and EMA positive, whereas the smaller cells were always negative. Interestingly smaller cells expressed only weak nuclear positivity for TTF1, whereas larger cells were TTF1 negative. Melanocytic markers were negative in both populations. Morphological patterns and immunohistochemical staining confirmed ocular ME and allowed to exclude pulmonary metastasis or primary malignant melanoma. The patient was successfully treated by brachytherapy alone and is alive and well 10 months after treatment. Diagn. Cytopathol. 2017;45:561-564. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Amir Mahdjoubi
- Department of Ophtalmology, Institut Curie 26, Rue d'Ulm, 75248, Paris Cedex, France
| | - Nathalie Cassoux
- Department of Ophtalmology, Institut Curie 26, Rue d'Ulm, 75248, Paris Cedex, France
| | | | - Laurence Desjardins
- Department of Ophtalmology, Institut Curie 26, Rue d'Ulm, 75248, Paris Cedex, France
| | - Jan Klos
- Department of Pathology, Institut Curie 26, Rue d'Ulm, 75248, Paris Cedex, France
| | - Martial Caly
- Department of Pathology, Institut Curie 26, Rue d'Ulm, 75248, Paris Cedex, France
| | - Tatjana Vlajnic
- Department of Pathology, Institut Curie 26, Rue d'Ulm, 75248, Paris Cedex, France
| | - Sophie Gardrat
- Department of Pathology, Institut Curie 26, Rue d'Ulm, 75248, Paris Cedex, France
| | - Jerzy Klijanienko
- Department of Pathology, Institut Curie 26, Rue d'Ulm, 75248, Paris Cedex, France
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Tian T, Ji XD, Zhang Q, Peng J, Zhao PQ. A delayed diagnosis of unsuspected retinoblastoma in an in vitro fertilisation infant with retinopathy of prematurity. Int J Ophthalmol 2016; 9:1361-3. [PMID: 27672607 DOI: 10.18240/ijo.2016.09.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 01/27/2016] [Indexed: 11/23/2022] Open
Affiliation(s)
- Tian Tian
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200082, China
| | - Xun-Da Ji
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200082, China
| | - Qi Zhang
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200082, China
| | - Jie Peng
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200082, China
| | - Pei-Quan Zhao
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200082, China
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42
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Khan L, Malukani K, Malaiya S, Yeshwante P, Ishrat S, Nandedkar SS. Role of Fine Needle Aspiration Cytology as a Diagnostic Tool in Orbital and Adnexal Lesions. J Ophthalmic Vis Res 2016; 11:287-95. [PMID: 27621787 PMCID: PMC5000532 DOI: 10.4103/2008-322x.188397] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose: To evaluate the role of fine needle aspiration (FNAC) as a diagnostic tool in cases of orbital and ocular adnexal masses. Cytological findings were correlated with histopathological diagnosis wherever possible. Methods: FNAC was performed in 29 patients of different age groups presenting with orbital and ocular adnexal masses. Patients were evaluated clinically and investigated by non-invasive techniques before fine needle aspiration of the masses. Smears were analyzed by a cytologist in all cases. Further, results of cytology were compared with the histopathological diagnosis. Results: The age of patients ranged from 1 to 68 years (mean: 29.79±19.29). There were 14 males and 15 females with a male to female ratio of 0.93:1. Out of 29 cases, 26 aspirates were cellular. Cellularity was insufficient in three (10.34%) aspirates. Out of 26 cellular aspirates, 11 were non-neoplastic while 15 were neoplastic on cytology. Subsequent histopathologic examination was done in 21/26 cases. Concordance rate of FNAC in orbital and ocular adnexal mass lesions with respect to the precise histologic diagnosis was 90%. Conclusion: When properly used in well-indicated patients (in cases where a diagnosis cannot be made by clinical and imaging findings alone), FNAC of orbital and periorbital lesions is an invaluable and suitable adjunct diagnostic technique that necessitates close cooperation between the ophthalmologist and cytologist. However, nondiagnostic aspirates may sometimes be obtained, and an inconclusive FNAC should not always be ignored.
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Affiliation(s)
- Lubna Khan
- Department of Ophthalmology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
| | - Kamal Malukani
- Department of Pathology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
| | - Siddharth Malaiya
- Department of Ophthalmology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
| | - Prashant Yeshwante
- Department of Pathology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
| | - Saba Ishrat
- Department of Ophthalmology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
| | - Shirish S Nandedkar
- Department of Pathology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
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Sellam A, Desjardins L, Barnhill R, Plancher C, Asselain B, Savignoni A, Pierron G, Cassoux N. Fine Needle Aspiration Biopsy in Uveal Melanoma: Technique, Complications, and Outcomes. Am J Ophthalmol 2016; 162:28-34.e1. [PMID: 26556006 DOI: 10.1016/j.ajo.2015.11.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/03/2015] [Accepted: 11/04/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To report the technical aspects, complications, and outcomes concerning fine needle aspiration biopsy (FNAB) in uveal melanoma. DESIGN Retrospective cohort study. METHODS Patients with uveal melanoma who underwent transscleral or transvitreal FNAB at an ocular oncology center were retrospectively evaluated. FNAB was performed if the tumor was more than 5 mm in thickness. Array comparative genomic hybridization analysis was performed on biopsy samples with sufficient tissue. The main outcome measures were success (sample that gave a successful result for biomarker analysis) rate, complications, liver metastasis, and overall survival. RESULTS There were 217 (114 male, 52%) consecutive study patients with a mean age of 56.7 (16-84) years. The mean follow-up period was 31 (range 3.6-61.3) months. Mean tumor thickness was 8.4 (range 5-12) mm. The overall success rate of the procedure was 169 patients (77.9%). Thirty-one patients (14.3%) experienced intravitreal hemorrhage, of whom 9 (4.1%) required vitreal surgery. There was no case of endophthalmitis, orbital dissemination, local recurrence, or rhegmatogenous retinal detachment. Thirty-two patients (14.7%) developed metastasis during the study, of whom 20 (9.2%) died. Of the 169 successful samples, 53 patients (31%) were classified as low risk, 41 (24%) as intermediate risk, and 54 (32%) as high risk. Fifteen patients (9%) did not have any detectable chromosomal abnormality and 6 (4%) could not be classified. CONCLUSION FNAB is a relatively safe and successful technique that can be routinely used to obtain tissue for molecular genomic analysis; such analysis helps determine the diagnosis and prognosis in uveal melanoma.
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Eide N, Garred Ø, Beiske K, Fodstad Ø. Bilateral uveal melanomas with different gene expression detected with 7 years interval. Acta Ophthalmol 2016; 94:99-102. [PMID: 26496992 DOI: 10.1111/aos.12857] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/12/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE To report a bilateral uveal melanoma detected in a micrometastasis study. METHOD Case report. RESULTS At enucleation of a circumpapillary amelanotic mixed melanoma in a patient with ocular melanocytosis, a pigmented lesion in the other eye was detected, thought to be a naevus. BAP1 was positive showing nuclear staining of the tumour cells. Seven years later the naevus showed growth and development of a retinal detachment. FNAB disclosed monosomy 3 in the spindle tumour cells. CONCLUSION A case of bilateral melanoma with long-term survival without metastatic diseases is reported. Different gene expressions in the two eyes were revealed. The case is a reminder that follow-up over years is essential in patients with a uveal melanoma, especially with ocular melanocytosis.
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Affiliation(s)
- Nils Eide
- Eye Department; Oslo University Hospital HF; Oslo Norway
| | - Øystein Garred
- Division of Pathology; Oslo University Hospital HF; Oslo Norway
| | - Klaus Beiske
- Division of Pathology; Oslo University Hospital HF; Oslo Norway
| | - Øystein Fodstad
- Department of Tumor Biology; Oslo University Hospital HF and University of Oslo; Oslo Norway
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45
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Diagnostic Cytologic Features of Uveal Melanoma. Ophthalmology 2015; 122:1580-4. [DOI: 10.1016/j.ophtha.2015.04.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/05/2015] [Accepted: 04/09/2015] [Indexed: 11/23/2022] Open
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Aziz HA, Martel JN, Biscotti CV, Singh AD, Shields CL. This, that, or something different? Surv Ophthalmol 2015; 60:495-9. [PMID: 26003618 DOI: 10.1016/j.survophthal.2015.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 05/15/2015] [Indexed: 11/28/2022]
Abstract
A 72-year-old man presented after a single choroidal mass was incidentally detected on fundus examination of his right eye. The patient has a history of multiple myeloma and neuroendocrine thymoma diagnosed 6 and 10 years before presentation, respectively. Fine-needle aspiration biopsy revealed metastatic choroidal carcinoid tumor. The patient was subsequently treated with brachytherapy (iodine-125).
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Affiliation(s)
- Hassan A Aziz
- Department of Ophthalmology, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Joseph N Martel
- Department of Ophthalmology, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Charles V Biscotti
- Department of Ophthalmology, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Arun D Singh
- Department of Ophthalmology, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Carol L Shields
- Department of Ophthalmology, Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
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Ophthalmic Metastasis of Breast Cancer and Ocular Side Effects from Breast Cancer Treatment and Management: Mini Review. BIOMED RESEARCH INTERNATIONAL 2015; 2015:574086. [PMID: 26078956 PMCID: PMC4442260 DOI: 10.1155/2015/574086] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 04/01/2015] [Accepted: 04/12/2015] [Indexed: 11/18/2022]
Abstract
Breast cancer is one of the most common malignant diseases occurring in women, and its incidence increases over the years. It is the main site of origin in ocular metastatic disease in women, and, due to its hematogenous nature of metastatic spread, it affects mainly the uveal tissue. The purpose of this paper is to summarize the clinical manifestations of the breast cancer ocular metastatic disease, alongside the side effects of the available treatment options for the management and regression of the systematic and ophthalmic disease.
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48
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Gokhale R, Medina CA, Biscotti CV, Singh AD. Diagnostic Fine-Needle Aspiration Biopsy for Iris Melanoma. Asia Pac J Ophthalmol (Phila) 2015; 4:89-91. [PMID: 26065351 DOI: 10.1097/apo.0000000000000083] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim of this study was to describe a case of iris melanoma diagnosed by fine-needle aspiration biopsy (FNAB) with review of the literature. DESIGN This study presents a case report and review of the literature. METHODS A 76-year-old white man presented with iris melanoma arising from preexisting iris nevus that was confirmed cytologically by a transcorneal FNAB. RESULTS A pigmented lesion on the left iris extending from 3 to 8:30 o'clock, from the iris root to the pupillary margin without ectropion uveae, was biopsied through 1-mm clear corneal incision. A short 25-gauge needle was inserted into the tumor while applying aspiration, and 10-0 suture was used to close the wound. Cytopathology confirmed the presence of spindle-shaped cells with conspicuous cytoplasmic melanin and nuclear atypia consistent with the diagnosis of melanoma. There were no intraoperative or postoperative complications. The patient was subsequently treated with radiation plaque brachytherapy. CONCLUSIONS Although indicated only in minority of cases, it is important to consider FNAB for the diagnosis and management of iris lesions.
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Affiliation(s)
- Rahul Gokhale
- From the *Cole Eye Institute and †Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH
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Beckwith-Cohen B, Bentley E, Dubielzig RR. Outcome of iridociliary epithelial tumour biopsies in dogs: a retrospective study. Vet Rec 2015; 176:147. [DOI: 10.1136/vr.102638] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Billie Beckwith-Cohen
- The Comparative Ocular Pathology Laboratory of Wisconsin (COPLOW), School of Veterinary Medicine, the University of Wisconsin-Madison; 2015 Linden Drive Madison Wisconsin 53706 USA
| | - Ellison Bentley
- Department of Surgical Sciences; School of Veterinary Medicine, The University of Wisconsin-Madison; 2015 Linden Drive Madison Wisconsin 53706 USA
| | - Richard R. Dubielzig
- The Comparative Ocular Pathology Laboratory of Wisconsin (COPLOW), School of Veterinary Medicine, the University of Wisconsin-Madison; 2015 Linden Drive Madison Wisconsin 53706 USA
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50
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Augsburger JJ, Corrêa ZM, Augsburger BD. Frequency and implications of discordant gene expression profile class in posterior uveal melanomas sampled by fine needle aspiration biopsy. Am J Ophthalmol 2015; 159:248-56. [PMID: 25448994 DOI: 10.1016/j.ajo.2014.10.026] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 10/22/2014] [Accepted: 10/24/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine the frequency of discordant gene expression profile (GEP) classification of posterior uveal melanomas sampled at 2 tumor sites by fine-needle aspiration biopsy (FNAB). DESIGN Prospective single-institution longitudinal study performed in conjunction with a multicenter validation study of the prognostic value of GEP class of posterior uveal melanoma cells for metastasis and metastatic death. METHODS FNAB aspirates of 80 clinically diagnosed primary choroidal and ciliochoroidal melanomas were obtained from 2 tumor sites prior to or at the time of initial ocular tumor treatment and submitted for independent GEP testing and classification. Frequency of discordant GEP classification of these specimens was determined. RESULTS Using the support vector machine learning algorithm favored by the developer of the GEP test employed in this study, 9 of the 80 cases (11.3% [95% confidence interval: 9.0%-13.6%]) were clearly discordant. If cases with a failed classification at 1 site or a low confidence class assignment by the support vector machine algorithm at 1 or both sites are also regarded as discordant, then this frequency rises to 13 of the 80 cases (16.3% [95% confidence interval: 13.0%-19.6%]). CONCLUSION Sampling of a clinically diagnosed posterior uveal melanoma at a single site for prognostic GEP testing is associated with a substantial probability of misclassification. Two-site sampling of such tumors with independent GEP testing of each specimen may be advisable to lessen the probability of underestimating an individual patient's prognostic risk of metastasis and metastatic death.
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