title: Autofluorescence quantification of benign and malignant choroidal nevomelanocytic tumors.
abstract: OBJECTIVE
  Accurate diagnosis of choroidal melanoma is challenging and has important implications for both physicians and patients. We assessed the utility of quantification of fundus autofluorescence in the evaluation and follow-up of choroidal nevomelanocytic tumors.
  
  
  OBJECTIVE
  To assess the utility of autofluorescence quantification in distinguishing clinically diagnosed choroidal nevi, melanoma, and indeterminate nevomelanocytic lesions.
  
  
  METHODS
  A retrospective observational study from 2006 to 2012 of patients with choroidal nevomelanocytic lesions who had digital autofluorescence and color fundus imaging performed at the University of Michigan Kellogg Eye Center.
  
  
  METHODS
  ImageJ software was used to output autofluorescence gray-scale values for each pixel of a 500 × 50-pixel region within each lesion and a corresponding adjacent control region.
  
  
  METHODS
  A single value was generated, termed the Index of Retinal Autofluorescence (IRA), to represent the total difference in gray-scale values between the 2 regions in each affected eye.
  
  
  RESULTS
  Thirteen of the 14 clinically diagnosed nevi exhibited an IRA less than 150 gray-scale intensity squared (gsi2). Eight of 9 clinically diagnosed melanomas exhibited an IRA more than 150 gsi2. An IRA of 150 gsi2 distinguished nevi from melanomas with a sensitivity of 0.89 and specificity of 0.93. Fifteen of 19 patients with indeterminate nevomelanocytic lesions underwent clinical assessment and initial imaging with clinical follow-up at a median of 10 months. All 3 patients with an IRA less than 150 gsi2 showed no evidence of clinical progression and 6 of 12 lesions with an IRA more than 150 gsi2 showed clinical progression to melanoma. An IRA of 150 gsi2 identifies indeterminate lesions that progressed to melanoma with a sensitivity of 1.00 and specificity of 0.33.
  
  
  CONCLUSIONS
  Quantification of digital autofluorescence images can differentiate between clinically benign and malignant choroidal nevomelanocytic lesions and may be predictive for clinical progression of indeterminate lesions.
authors.affiliation: Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI 48105, USA.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Albertus
authors.forename: Ira H
authors.initials: IH
authors.lastname: Schachar
authors.forename: Sarwar
authors.initials: S
authors.lastname: Zahid
authors.forename: Victor M
authors.initials: VM
authors.lastname: Elner
authors.forename: Hakan
authors.initials: H
authors.lastname: Demirci
authors.forename: Thiran
authors.initials: T
authors.lastname: Jayasundera
mesh_terms: D002830:Choroid Neoplasms / Q000175:diagnosis*; D003937:Diagnosis, Differential; D018450:Disease Progression; D005451:Fluorescein Angiography; D006801:Humans; D008545:Melanoma / Q000175:diagnosis*; D008548:Melanosis / Q000175:diagnosis*; D009508:Nevus, Pigmented / Q000175:diagnosis*; D010865:Pilot Projects; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity