Novel Guarded Needle Trans-Scleral Biopsy for Uveal Melanoma: A Pilot Study

2021 ◽  
pp. 1-4
Author(s):  
Abtin Shahlaee ◽  
Musa Abdelaziz ◽  
Michael I. Seider
Keyword(s):  
San Francisco ◽  
Uveal Melanoma ◽  
Case Series ◽  
Needle Aspiration ◽  
Kaiser Permanente ◽  
Basal Diameter ◽  
Needle Technique ◽  
Initial Cohort ◽  
Tumor Perforation ◽  
A Minor

<b><i>Introduction:</i></b> Trans-scleral biopsy of uveal melanoma (UM) poses an inherent risk of tumor and possibly retinal perforation. We describe a novel technique for trans-scleral biopsy of UM and evaluate its safety and efficacy in an initial cohort of patients. <b><i>Methods:</i></b> A retrospective, consecutive observational case series was conducted from October 14, 2019, to April 15, 2020, at Kaiser Permanente, San Francisco, CA among patients with UM of the ciliary body or anterior choroid undergoing trans-scleral fine-needle aspiration biopsy using a novel guarded needle technique. <b><i>Results:</i></b> A total of 6 patients were included in the study, with a mean age of 64.3 (range 35–77) years (5 women 83%). Mean (±SD) tumor thickness and maximal basal diameter were 6.4 (±2.66) and 11.9 (±2.13) mm, respectively. Five out of 6 patients achieved a successful biopsy with reliable gene expression profiling (GEP) results. The only failure to obtain specimen occurred in the first attempted patient and, after a minor technique modification, all subsequent biopsies were successful. No intraoperative or short-term postoperative complications were observed in any patient. <b><i>Conclusion:</i></b> This novel trans-scleral biopsy technique appears to be safe and effective when obtaining UM tissue for GEP. This method may provide a more controlled biopsy depth thereby minimizing the risk of tumor perforation and its associated complications while still obtaining adequate biopsy yield.

Five-Year Follow-up of Microincisional Vitrectomy Surgery, Endolaser Tumor Ablation, and Gene-Expression Profiling in Small Uveal Melanoma

2020 ◽  
pp. 247412642097287
Author(s):  
Timothy G. Murray ◽  
Victor M. Villegas ◽  
Austin Bach ◽  
Aaron S. Gold
Keyword(s):  
Uveal Melanoma ◽  
Choroidal Melanoma ◽  
Case Series ◽  
Subretinal Fluid ◽  
Molecular Classification ◽  
Needle Aspiration ◽  
Tumor Ablation ◽  
Tumor Control ◽  
Intravitreal Triamcinolone

Purpose: This work evaluates a microincisional vitrectomy surgical (MIVS) approach to endolaser ablation of small uveal malignant melanoma by incorporating genetic tumor classification as a means to avoid radiotherapy while maintaining local tumor control without compromising visual acuity (VA). Methods: An institutional review board–approved, single-surgeon, retrospective analysis was conducted of a consecutive case series of all patients with tumors less than 2.5 mm in apical thickness who underwent MIVS, endolaser tumor ablation, fine-needle aspiration biopsy (FNAB), and intravitreal triamcinolone acetonide for small uveal melanoma between 2012 and 2015. Results: A total of 226 patients underwent FNAB from January 2012 to January 2015 for uveal melanoma. All 58 patients treated for a small uveal melanoma were included. This group of patients had a minimum follow-up of 60 months (range, 60-93 months). At initial diagnosis, subretinal fluid was present in 52 eyes (89.1%), macular edema was present in 24 eyes (41.4%), and epiretinal membrane was present in 11 eyes (20.1%). Fifty-six specimens (96.5%) received a molecular classification of either class 2 (4 of 56, 7.1%) or class 1 (52 of 56, 92.8%). Initial VA was 20/40 or better in 26 eyes (44.8%), and final VA was 20/40 or better in 48 of 58 eyes (82.8%). Conclusions: Endolaser tumor ablation delivered at MIVS surgery enables excellent tumor control (98.3%) and improves VA to better than 20/40 in more than 80% of treated eyes. FNAB achieves molecular classification in 96.5% of all patients undergoing treatment for small choroidal melanoma independent of tumor size.

Fine-Needle Aspiration Biopsy for Molecular Genomic Classification: Evaluation of Transscleral vs Transvitreal Biopsy

2018 ◽  
Vol 2 (4) ◽  
pp. 208-212 ◽  
Author(s):  
Victor M. Villegas ◽  
Aaron Gold ◽  
Timothy G. Murray
Keyword(s):  
Uveal Melanoma ◽  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Biopsy ◽  
Case Series ◽  
Molecular Classification ◽  
Needle Aspiration ◽  
Aspiration Biopsy ◽  
Multiple Gene ◽  
Fine Needle ◽  
Needle Aspiration Biopsy

Purpose: To evaluate the transvitreal and transscleral fine-needle aspiration biopsy (FNAB) approach for molecular classification with gene-expression profiling (GEP) of uveal melanoma. Methods: Institutional review board–approved single-surgeon retrospective analysis of a consecutive case series of all patients undergoing FNAB using a 25-gauge-needle multipass approach for GEP analysis of uveal melanoma between 2012 and 2016. All FNAB specimens were processed for uveal melanoma diagnostic testing using a standard processing approach, and all testing was completed at a single laboratory (Castle Biosciences, Inc.). Results: Three hundred fifty-three eyes (353 patients) were included. Transvitreal biopsies were performed in 216 eyes (216/353, 61.2%), whereas transscleral biopsies were performed in 137 eyes (137/353, 38.8%). Twenty biopsies exhibited multiple gene failure (20/353, 5.6%). Excessive fluid biopsy volume was the primary association with reported multiple gene failure, occurring in 10 of 20 eyes (50%). FNAB performed via the transvitreal approach was significantly more likely to have an excessive volume report compared with transscleral biopsy (18/216, 8.3% vs 1/137, 0.7%; P < .001). Conclusions: FNAB performed via a transscleral or transvitreal multipass approach utilizing a 25-gauge needle achieves molecular classification in 95% of all patients undergoing treatment for presumed uveal melanoma independent of tumor size. Complications related to FNAB using these techniques are rare and may be associated with the presentation of the uveal melanoma.

Small Choroidal Melanoma: Correlation of Growth Rate with Pathology

2021 ◽  
pp. 1-10
Author(s):  
Vishal Raval ◽  
Shiming Luo ◽  
Emily C. Zabor ◽  
Arun D. Singh
Keyword(s):  
Growth Rate ◽  
Retinal Pigment ◽  
Choroidal Melanoma ◽  
Case Series ◽  
Subretinal Fluid ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Basal Diameter ◽  
Orange Pigment ◽  
Rpe Atrophy

<b><i>Purpose:</i></b> The aim of the study was to evaluate equivalence of growth rate and pathologic confirmation in small choroidal melanoma (SCM). <b><i>Design:</i></b> This study is a case series. <b><i>Subjects, Participants, and Controls:</i></b> A total of 61 patients with a choroidal melanocytic tumor of size 5.0–16.0 mm in the largest basal diameter and 1.0–2.5 mm in thickness were classified into the pathology-confirmed group (<i>n</i> = 19), growth-confirmed group (<i>n</i> = 30), and with combined observations (<i>n</i> = 12). <b><i>Methods:</i></b> Distribution of clinical variables (age, gender, laterality, tumor dimensions, tumor location, and presence of orange pigment, subretinal fluid, drusen, and retinal pigment epithelial [RPE] atrophy) between the groups was analyzed. Patient and disease characteristics were summarized as the median and interquartile range for continuous variables and the frequency and percentage for categorical variables. Comparisons were made using the Wilcoxon rank sum test for continuous variables and either Fisher’s exact test or the χ<sup>2</sup> test for categorical variables with a <i>p</i> value threshold of 0.05 for statistical significance. Growth rate (change in basal dimension/12 months) diagnostic of SCM was quantified. <b><i>Main Outcome Measures:</i></b> The primary aim of this study was to test the hypothesis that “growth” was diagnostic of SCM with the secondary aim of quantifying the malignant “growth rate” (growth rate of SCM). <b><i>Results:</i></b> The clinical characteristics among all 3 groups were similar except more patients with symptoms (68 vs. 20 vs. 42%, <i>p</i> = 0.004) and juxtapapillary location (<i>p</i> = 0.03) were in the pathology group than in the growth-confirmed group. Those in the combined and growth-confirmed groups had more patients with drusen (11 vs. 60 vs. 50%, <i>p</i> = 0.003) and RPE atrophy (11 vs. 23 vs. 67%, <i>p</i> = 0.003), respectively, than in the pathology group. The median time to detect growth was 9 months (range 3–26 months). The mean growth rate in basal dimension was 1.8 mm/12 months (range, 0.0–7.4 mm; [95% CI: 1.32–2.28]). <b><i>Conclusions and Relevance:</i></b> Choroidal melanocytic lesions exhibiting a defined growth rate can be clinically diagnosed as SCM without a need for biopsy.

Ultrasound Biomicroscopy Documented Anterior Uveal Melanoma Regression after Ruthenium-106 Plaque Therapy

2021 ◽  
pp. 1-9
Author(s):  
Biljana Kuzmanović Elabjer ◽  
Mladen Bušić ◽  
Andrej Pleše ◽  
Mirjana Bjeloš ◽  
Daliborka Miletić ◽  
...  
Keyword(s):  
Uveal Melanoma ◽  
Tumor Regression ◽  
Corneal Thickness ◽  
Case Series ◽  
Ultrasound Biomicroscopy ◽  
Close Monitoring ◽  
Single Institution ◽  
Retrospective Case ◽  
Caucasian Patients

<b><i>Introduction:</i></b> Ultrasound biomicroscopy (UBM) is the only widely used method for the evaluation of anterior uveal melanoma (AUM). <b><i>Objective:</i></b> Documentation of regression of AUM treated with ruthenium-106 (Ru-106) plaque types CCB and CCC using UBM. <b><i>Methods:</i></b> This single institution-based retrospective case series involved 10 Caucasian patients with AUM followed after brachytherapy with UBM from January 2014 until February 2019. The largest prominence of the tumor perpendicular to the sclera or the cornea (including scleral/corneal thickness) (<i>D</i>) and the largest basal dimension (<i>B</i>) were measured in millimeters with UBM for all patients prior to the brachytherapy and at 4-month interval follow-up. Tumor regression was calculated as a percentage of decrease in the initial <i>D</i> and <i>B</i> values. <b><i>Results:</i></b> The study involved 10 patients with a mean age of 64.4 years (yr) (range 46–80 yr). <i>D</i> ranged from 1.82 to 5.5 mm (median 2.99 mm) and <i>B</i> from 2.32 to 12.38 mm (median 4.18 mm). The apical radiation dose in all patients was 100 Gy. The median follow-up was 42.02 months. Regression for <i>D</i> was 21.11 ± 13.66%, 31.09 ± 14.66%, and 34.92 ± 19.86% at 1st, 2nd, and 3rd year of the follow-up, respectively, while for <i>B</i> it was 21.58 ± 16.05%, 28.98 ± 17.71%, and 32.06 ± 18.96%, respectively. Tumor recurrence was documented in 2/10 patients. <b><i>Conclusion:</i></b> The major regression of AUM, treated with Ru-106 plaque types CCB and CCC, was documented in the first 2 years after brachytherapy in our study group. In the following years, only minimal regression was documented that warns of the need for close monitoring and active search for local recurrences.

scholarly journals Standing on the shoulders of Giants: a citation analysis of the paediatric congenital heart disease literature

2021 ◽  
pp. 1-9
Author(s):  
Daniel P. Sew ◽  
Nigel E. Drury
Keyword(s):  
Citation Analysis ◽  
San Francisco ◽  
Citation Count ◽  
Case Series ◽  
Scientific Progress ◽  
The United States ◽  
Original Research ◽  
Prolific Author ◽  
Journal Citation Reports ◽  
The Impact

Abstract Objective: The citation history of a published article reflects its impact on the literature over time. We conducted a comprehensive bibliometric analysis to identify the most cited papers on CHD in children. Methods: One-hundred and ninety journals listed in Journal Citation Reports were accessed via Web of Science. Publications with 250 or more citations were identified from Science Citation Index Expanded (1900–2020), and those relating to structural CHD in children were reviewed. Articles were ranked by citation count and the 100 most cited were analysed. Results: The number of citations ranged from 2522 to 309 (median 431, IQR 356–518), with 35 published since 2000. All were written in English, most originated from the United States (74%), and were published in cardiovascular journals, with Circulation (28%) the most frequent. There were 86 original research articles, including 50 case series, 14 cohort studies, and 10 clinical trials. The most cited paper was by Hoffman JI and Kaplan S on the incidence of CHD. Thirteen authors had 4 or more publications in the top 100, all of whom had worked in Boston, Philadelphia, San Francisco, or Dallas, and the most prolific author was Newburger JW (9 articles). Conclusions: Citation analysis provides a historical perspective on scientific progress by assessing the impact of individual articles. Our study highlights the dominant position of US-based researchers and journals in this field. Most of the highly cited articles remain case series, with few randomised controlled trials in CHD appearing in recent years.

Chalastospora gossypii in a Maine Coon cat: case report and literature review

2021 ◽  
pp. 104063872110222
Author(s):  
Samantha M. Norris ◽  
Paula A. Schaffer ◽  
Noah B. Bander
Keyword(s):  
Soft Tissue ◽  
Needle Aspiration ◽  
Tissue Mass ◽  
Large Numbers ◽  
Formalin Fixed Paraffin ◽  
Formalin Fixed Paraffin Embedded ◽  
Soft Tissue Masses ◽  
Subcutaneous Mass ◽  
The Right ◽  
A Minor

A 15-y-old castrated male Maine Coon cat was evaluated for an ulcerated soft tissue mass on the right hindlimb that had been observed for 4 mo and had grown rapidly. A 3 × 3 cm soft, raised, amorphous, and ulcerated subcutaneous mass was observed on the lateral right metatarsus. In-house cytology via fine-needle aspiration was nondiagnostic. Incisional biopsy of the mass and further staging was declined, and amputation was elected. The amputated limb was submitted for histopathology, which revealed severe chronic nodular granulomatous dermatitis and multifocal granulomatous popliteal lymphadenitis with large numbers of intralesional fungal hyphae. Fungal PCR and sequencing on formalin-fixed, paraffin-embedded tissue identified Chalastospora gossypii. No adjunctive therapy was elected at the time. The patient has done well clinically 1 y post-operatively. C. gossypii is a rare microfungus found worldwide and is considered a minor pathogen of several plants. To our knowledge, infection by this fungus has not been reported previously in veterinary species. Features in our case are comparable to other mycotic infections. Nodular granulomatous mycotic dermatitis and cellulitis, although uncommon, should be a differential for soft tissue masses in veterinary species; C. gossypii is a novel isolate.

scholarly journals Ischemia Is Related to Tumour Genetics in Uveal Melanoma

Cancers ◽  
2019 ◽  
Vol 11 (7) ◽  
pp. 1004 ◽  
Author(s):  
Niels J. Brouwer ◽  
Annemijn P. A. Wierenga ◽  
Gülçin Gezgin ◽  
Marina Marinkovic ◽  
Gregorius P. M. Luyten ◽  
...  
Keyword(s):  
Uveal Melanoma ◽  
Messenger Rna ◽  
Tumour Size ◽  
Hypoxia Inducible Factor ◽  
The Cancer Genome Atlas ◽  
Basal Diameter ◽  
Von Hippel Lindau ◽  
The Status ◽  
Using Data ◽  
Tumour Genetics

Hypoxia-inducible factor 1-alpha (HIF1a) and its regulator von Hippel–Lindau protein (VHL) play an important role in tumour ischemia. Currently, drugs that target HIF1a are being developed to treat malignancies. Although HIF1a is known to be expressed in uveal melanoma (UM), it is as yet unknown which factors, such as tumour size or genetics, determine its expression. Therefore, we aimed to determine which tumour characteristics relate to HIF1a expression in UM. Data from 64 patients who were enucleated for UM were analysed. Messenger RNA (mRNA) expression was determined with the Illumina HT-12 v4 chip. In 54 cases, the status of chromosomes 3 and 8q, and BRCA1-associated protein 1 (BAP1) protein expression (immunohistochemistry) were determined. Findings were corroborated using data of 80 patients from the Cancer Genome Atlas (TCGA) study. A significantly increased expression of HIF1a, and a decreased expression of VHL were associated with monosomy 3/loss of BAP1 expression. The relationship between BAP1 loss and HIF1a expression was independent of chromosome 3. The largest basal diameter and tumour thickness showed no relationship with HIF1a. HIF1a expression related to an increased presence of infiltrating T cells and macrophages. From this study, we conclude that HIF1a is strongly related to tumour genetics in UM, especially to loss of BAP1 expression, and less to tumour size. Tumour ischemia is furthermore related to the presence of an inflammatory phenotype.

scholarly journals Transesophageal endoscopic ultrasound fine needle aspiration of vertebral body osteolytic tumors – a novel diagnostic approach. Case series.

2020 ◽  
Author(s):  
Romeo Ioan Chira ◽  
Alina Florea ◽  
Vlad Ichim ◽  
Liliana Rogojan ◽  
Alexandra Chira ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Histopathological Examination ◽  
Traditional Approach ◽  
Case Series ◽  
Lumbar Vertebrae ◽  
Needle Aspiration ◽  
Ct Guided ◽  
Fine Needle

Aims: Vertebral lesions, either primary or more frequently metastasis, are difficult targets for percutaneous guided biopsies and surgical biopsies and are associated with greater risks of complications. We investigated the feasibility of endoscopic ultrasound (EUS) fine needle aspiration (FNA) biopsy in the assessment of vertebral osteolytic tumors as an alternative to CT guided biopsy which is the technique currently used.Material and methods: Four patients with osteolytic tumors of the vertebral bodies identified by imaging methods (CT or MRI) – 3 patients, and one with a tumor detected primarily during EUS procedure were included in order to evaluate the feasibility of the procedure. The lesions were located either at the dorsal or lumbar vertebrae. In all cases we performed EUS FNA of the osteolytic vertebral body lesions with 22G needles using the transesophageal or transgastric approach.Results: In all cases EUS FNA provided enough tissue for an accurate histopathological report, with no procedural complication. We diagnosed lung adenocarcinoma, hepatocarcinoma and a pancreatic adenocarcinoma vertebral metastasis and one case of lymphoma.Conclusions: EUS FNA is a valuable technique which should be considered in selected cases, when a “traditional approach” is not applicable or associated with a higher risk. Treatment guidelines are based on the histology of the tumor, histopathological examination being nowadays mandatory. Therefore, we propose for selected cases a feasible technique, with significantly lower procedural risks, as an alternative for open surgical biopsies or computed tomography guided biopsies

The Heterogeneous Distribution of Monosomy 3 in Uveal Melanomas: Implications for Prognostication Based on Fine-Needle Aspiration Biopsies

2007 ◽  
Vol 131 (1) ◽  
pp. 91-96 ◽  
Author(s):  
Willem Maat ◽  
Ekaterina S. Jordanova ◽  
Shama L. van Zelderen-Bhola ◽  
Ed R. Barthen ◽  
Hans W. Wessels ◽  
...  
Keyword(s):  
Uveal Melanoma ◽  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Biopsy ◽  
Needle Aspiration ◽  
Chromosome 3 ◽  
Fish Analysis ◽  
Paraffin Sections ◽  
Heterogeneous Distribution ◽  
Fine Needle ◽  
Monosomy 3

Abstract Context.—The detection of monosomy 3 in uveal melanomas has repeatedly been associated with adverse outcome. Fine-needle aspiration biopsy is being used to detect monosomy 3 in these tumors, based on the assumption that this chromosomal abnormality is distributed homogeneously throughout the tumor. Objective.—To study the distribution of monosomy 3 in primary uveal melanoma by fluorescence in situ hybridization (FISH). Design.—We studied 50 enucleated eyes with uveal melanoma. In all 50 tumors we performed cytogenetic analysis and FISH using a DNA-specific probe for the centromere region of chromosome 3 on cultured tumor cells. In addition, the percentage of tumor cells with monosomy 3 was assessed by FISH on nuclei, isolated from paraffin-embedded tissue and compared to results of FISH on regular histology sections of the paraffin-embedded tissue. Results.—Combining karyotyping and FISH on cultured cells identified monosomy 3 in 19 (38%) of 50 tumors, whereas FISH on nuclei isolated from paraffin-embedded tissue showed 31 (62%) of 50 as having monosomy for chromosome 3. FISH analysis on paraffin sections showed tumor heterogeneity for copy number of chromosome 3 in at least 7 cases. Conclusions.—FISH analysis on paraffin sections shows that heterogeneity of monosomy of chromosome 3 is a frequent phenomenon in uveal melanoma. FISH on nuclei isolated from paraffin-embedded tissue identifies a higher frequency of monosomy 3 than the traditional combination of karyotyping and FISH on cultured uveal melanoma cells. The practice of assigning patients to risk categories based on fine-needle aspiration biopsy samples from primary uveal melanoma may be subject to error based on the heterogeneous distribution of monosomy 3 in these tumors.

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