Kernt Marcus, Schaller Ulrich C, Stumpf Carmen, Ulbig Michael W, Kampik Anselm, Neubauer Aljoscha S
Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany.
Clin Ophthalmol. 2010 Jul 30;4:829-36. doi: 10.2147/opth.s11864.
Clinical differentiation of choroidal pigmented lesions is sometimes difficult. Choroidal melanoma is the most prevalent primary neoplasia among malignant ocular tumors, and metastasis often occurs before the primary tumor is diagnosed. Therefore, early detection is essential. We investigated the imaging properties of clinically diagnosed melanocytic choroidal tumors using a nonmydriatic ultra-wide-field scanning laser ophthalmoscope (SLO) with two laser wavelengths to distinguish benign from malignant lesions. Repeated standardized ultrasound (US) evaluation provided reference standard.
In a consecutive series of 49 patients with clinically diagnosed melanocytic choroidal tumors in one eye, 29 had established melanoma (defined by proven growth on repeated US follow-up) and 20 had nevi (defined by no malignancy according to clinical, US, and growth characteristics for at least 2 years). All patients underwent clinical examination, undilated Optomap((R)) (Optos PLC, Dunfermline, Fife, Scotland, UK) imaging, standardized US examination, and standard retinal photography. Measurements of the tumor base using the Optomap software were compared with US B-scan measurements. Imaging characteristics from the SLO images were correlated with the structural findings in the two patient groups.
Measurements of tumor base correlated well between SLO and US with r = 0.61 (T-direction) and r = 0.51 (L-direction). On SLO imaging, typical malignant lesions appeared dark on the red laser channel and bright on the green laser channel. Based on those simple binary characteristics, a sensitivity of 76% at a specificity of 70% was obtained for a correct classification of lesions. When analogous to clinical examination lesion size, margin touching the optic disc, and existence of subretinal fluid were additionally considered, 90% sensitivity at 82% specificity was obtained.
In this first, limited series, nonmydriatic SLO imaging with two laser wavelengths permitted to differentiate malignant ocular tumors from nonmalignant lesions with high diagnostic accuracy. Additional parameters may further enhance diagnostic properties, but larger patient series are required to validate our findings and prove the diagnostic properties.
脉络膜色素性病变的临床鉴别有时存在困难。脉络膜黑色素瘤是恶性眼肿瘤中最常见的原发性肿瘤，且转移常发生在原发性肿瘤被诊断之前。因此，早期检测至关重要。我们使用具有两种激光波长的免散瞳超广角扫描激光检眼镜（SLO）研究了临床诊断的脉络膜黑色素细胞肿瘤的成像特性，以区分良性和恶性病变。重复的标准化超声（US）评估提供了参考标准。
在连续的49例单眼临床诊断为脉络膜黑色素细胞肿瘤的患者系列中，29例已确诊为黑色素瘤（根据重复的超声随访证实有生长来定义），20例为痣（根据临床、超声和生长特征至少2年无恶性来定义）。所有患者均接受了临床检查、未散瞳的Optomap（R）（Optos PLC，邓弗姆林，法夫，苏格兰，英国）成像、标准化超声检查和标准视网膜摄影。使用Optomap软件测量肿瘤基底并与超声B超测量结果进行比较。SLO图像的成像特征与两组患者的结构发现相关。
SLO和US之间肿瘤基底测量的相关性良好，T方向r = 0.61，L方向r = 0.51。在SLO成像上，典型的恶性病变在红色激光通道上呈暗色，在绿色激光通道上呈亮色。基于这些简单的二元特征，病变正确分类的敏感性为76%，特异性为70%。当另外考虑类似于临床检查的病变大小、边缘接触视盘以及视网膜下液的存在时，敏感性为90%，特异性为82%。
在这个首个有限的系列研究中，具有两种激光波长的免散瞳SLO成像能够以高诊断准确性区分恶性眼肿瘤和非恶性病变。其他参数可能会进一步提高诊断性能，但需要更大的患者系列来验证我们的发现并证明诊断性能。
