[脉络膜转移癌的眼底荧光血管造影及脉络膜转移癌与原发性脉络膜黑色素瘤的鉴别诊断]

[Fundus fluorescein angiography in metastatic choroidal carcinomas and differentiating metastatic choroidal carcinomas from primary choroidal melanomas].

作者信息

Li Lei, Wang Wen-Ji, Chen Rong-Jia, Qian Jiang, Luo Chuan-Qi, Zhang Yong-Jin, Shen Ying, Ye Xiao-Feng, Gao Qiao-Yun

机构信息

Department of Ophthalmology, Eye Ear Nose and Throat Hospital of Fudan University, Shanghai 200031, China.

出版信息

Zhonghua Yan Ke Za Zhi. 2011 Jan;47(1):27-34.

PMID:21418924

Abstract

OBJECTIVE

To investigate the characteristics of fundus fluorescein angiography (FFA) in metastatic choroidal carcinomas and determine the value of FFA in differentiating metastatic choroidal carcinomas from primary choroidal melanomas.

METHODS

It was a retrospective case series. The retrospective analysis of clinical data and FFA findings was performed in 23 eyes of 22 patients with metastatic choroidal carcinomas and 31 eyes of 31 patients with primary choroidal melanomas as the control.

RESULTS

Ocular fundus findings of metastatic choroidal carcinomas were divided into three types: solitary flat (tumor thickness less than 3 mm), solitary elevated (tumor thickness more than 3 mm) or diffuse type. FFA of the three types showed hypofluorescence during the arterial phase and progressive hyperfluorescence during the subsequent phases. The border of the lesions revealed retinal capillary dilation during the arteriovenous phase and persistent pinpoint leakage throughout the angiogram. Retinal capillary dilation and pinpoint leakage were more frequently presented in the solitary flat type. Simultaneous visualization of retinal and tumor circulation (the so called double circulation) was more frequently presented in the solitary elevated type. Pinpoint leakage could be detected in 17 (73.91%) eyes of metastatic choroidal carcinomas and in 5 (16.13%) eyes of primary choroidal melanomas. The difference between the visibility of pinpoint leakage in metastatic choroidal carcinomas and primary choroidal melanomas was statistically significant (P = 0.0000). When pinpoint leakage of FFA was used to differentiate metastatic choroidal carcinomas from primary choroidal melanomas, the sensitivity, specificity, accuracy, positive and negative predictive values were 73.91%, 83.87%, 79.63%, 77.27%, 81.25% respectively.

CONCLUSIONS

FFA is helpful for the diagnosis of metastatic choroidal carcinomas. Pinpoint leakage on the border of lesions has some value in differentiating metastatic choroidal carcinomas from primary choroidal melanomas.

摘要

目的

探讨转移性脉络膜癌的眼底荧光血管造影（FFA）特征，确定FFA在鉴别转移性脉络膜癌与原发性脉络膜黑色素瘤中的价值。

方法

这是一项回顾性病例系列研究。对22例转移性脉络膜癌患者的23只眼和31例原发性脉络膜黑色素瘤患者的31只眼作为对照进行临床资料和FFA检查结果的回顾性分析。

结果

转移性脉络膜癌的眼底表现分为三种类型：孤立扁平型（肿瘤厚度小于3mm）、孤立隆起型（肿瘤厚度大于3mm）或弥漫型。三种类型的FFA在动脉期均表现为低荧光，随后各期逐渐出现高荧光。病变边界在动静脉期显示视网膜毛细血管扩张，整个血管造影过程中持续出现点状渗漏。视网膜毛细血管扩张和点状渗漏在孤立扁平型中更为常见。视网膜和肿瘤循环同时显影（即所谓的双循环）在孤立隆起型中更为常见。转移性脉络膜癌17只眼（73.91%）和原发性脉络膜黑色素瘤5只眼（16.13%）可检测到点状渗漏。转移性脉络膜癌和原发性脉络膜黑色素瘤中点状渗漏的可见性差异具有统计学意义（P = 0.0000）。当用FFA的点状渗漏来鉴别转移性脉络膜癌与原发性脉络膜黑色素瘤时，敏感性、特异性、准确性、阳性和阴性预测值分别为73.91%、83.87%、79.63%、77.27%、81.25%。