FINE-NEEDLE ASPIRATION BIOPSY OF SUSPECTED INTRAOCULAR NEOPLASMS: INDICATIONS, INSTRUMENTATION, TECHNIQUES AND RESULTS

James J. Augsburger

Fine-needle aspiration biopsy (FNAB) has been performed by the author as a diagnostic procedure on over 350 selected patients with a clinically suspected malignant intraocular neoplasm during the past 20 years. The author's principal current indications for FNAB are (1) major diagnostic uncertainty [most frequently (a) metastatic carcinoma vs amelanotic choroidal melanoma, (b) large benign choroidal nevus vs small malignant choroidal melan-oma], (2) suspected metastatic cancer to intraocular tissues in patient with no other clini-cally evident primary or metastatic cancer more amenable to biopsy, (3) suspected primary intraocular lymphoma in patients with one or more prominent uveal or retinal masses consistent with lymphomatous infiltrates but no clinically detectable lymphoma in the central nervous system or viscera and few or no vitreous cells or a prior inconclusive or negative vitreous biopsy, and (4) patient request for confirmation of the clinical diagnosis prior to consenting to recommended treatment. In this presentation, the author will describe the instruments he currently uses for intraocular FNAB, the alternative surgical approaches he has developed for tumors of various suspected types, sizes, and locations, the surgical steps he takes during performance of the different types of biopsies, the pathologic methods his cytopathologic colleagues employ for processing and interpretation of the tumor aspirates, the yield of tumor cells the authors has come to expect, and the diagnostic results and complications he has encountered in selected patient subgroups. If time permits, the author will also describe current investigational applications of FNAB in patients with clinically diagnosed primary posterior uveal melanoma (especially cytomorphometric analysis and cytogenetic studies on FNAB-derived tumor aspirates).


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