Histopathologic Analysis of Transvitreal Fine Needle Aspiration Biopsy Needle Tracts for Uveal Melanoma.
OBJECTIVE
Perform the first in vivo examination of fine needle aspiration biopsy (FNAB) scleral tracts to determine the incidence of iatrogenic extension of tumor cells.


METHODS
A prospective, consecutive, observational case series.


METHODS
This study was performed in a clinical/surgical setting at Retina Consultants of Houston and Houston Methodist Hospital, Houston, Texas, and included 10 patients who were scheduled for enucleation as primary treatment for uveal melanoma. Treatment included FNAB, enucleation, and histopathologic analysis. The primary outcomes were tumor location and dimension as identified by B-scans and histopathologic analysis. Tumor type was classified by gene expression profile and American Joint Committee on Cancer staging. Twenty-five- or 27-gauge needles were used for FNAB under direct visualization. Cell blocks of acquired specimens were examined using hematoxylin-eosin stain and double immunostain using HMB45 with red chromogen and Ki67 with brown 3,3'-diaminobenzidine chromogen.


RESULTS
Mean follow-up after enucleation was 20.4 months (range 9.9-31.7). All biopsy specimens had adequate yields for genomic analysis. No enucleation specimen contained tumor cells within sclera, pars plana, or pars plicata. One specimen contained a small collection of tumor cells within the anterior vitreous in the quadrant of the biopsy site. No patient developed an orbital recurrence. Four patients developed nonorbital metastatic uveal melanoma during the study period. Three of them died, and 1 is alive with hepatic metastasis.


CONCLUSIONS
No iatrogenic extension of tumor was reported. FNAB is a safe procedure that produces a high cellular yield for cytologic and genomic analyses with minimal risk of extraocular dissemination.
Retina Consultants of Houston, Houston, Texas.
Ryan S
RS
Kim
Ophthalmology, Pathology, and Genomic Medicine, Houston Methodist Hospital, Houston, Texas; Pathology and Laboratory Medicine, Weill Cornell Medicine, Houston, Texas; Blanton Eye Institute, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas.
Patricia
P
Chevez-Barrios
Retina Consultants of Houston, Houston, Texas.
Maria E
ME
Bretana
Retina Consultants of Houston, Houston, Texas.
Tien P
TP
Wong
Department of Radiation Oncology, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas.
Bin S
BS
Teh
Retina Consultants of Houston, Houston, Texas; Blanton Eye Institute, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas. Electronic address: acsmd@houstonretina.com.
Amy C
AC
Schefler
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000009:adverse effects / Q000379:methods*; D015353:Eye Enucleation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000601:surgery; D008875:Middle Aged; D009366:Neoplasm Seeding; D009367:Neoplasm Staging / Q000379:methods*; D011446:Prospective Studies; D012590:Sclera / Q000473:pathology*; D013997:Time Factors; D014604:Uveal Neoplasms / Q000175:diagnosis* / Q000601:surgery; D014822:Vitreous Body; D055815:Young Adult; D000098943:Uveal Melanoma