Department of Ophthalmology and the Jules Stein Eye Institute, University of California, Los Angeles, California, USA.
Ophthalmology. 2012 Mar;119(3):606-10. doi: 10.1016/j.ophtha.2011.08.046. Epub 2012 Jan 9.
To report the local and systemic follow-up of patients undergoing transscleral intraoperative fine-needle aspiration biopsy (FNAB) at the time of iodine-125 plaque brachytherapy for the treatment of choroidal melanoma.
Retrospective, single-center, consecutive case cohort study.
A total of 170 consecutive patients with choroidal melanoma.
All patients with choroidal melanoma treated with iodine-125 brachytherapy and intraoperative FNAB from January 2005 to January 2010 with at least 1 year of clinical follow-up were included.
Outcomes examined were endophthalmitis, orbital dissemination, local treatment failure, rhegmatogenous retinal detachment, monosomy 3 status, and choroidal melanoma metastasis.
A total of 170 consecutive patients with clinical diagnosis of choroidal melanoma, intraoperative FNAB, and post-brachytherapy follow-up of 1 to 6 years (mean, 2.7 ± 1.3 years) were included. For tumors with height of <3.0 mm, 3.0 to 5.0 mm, and >5.0 mm, sufficient biopsy material for fluorescence in situ hybridization (FISH) was obtained in 53%, 68%, and 91%, respectively. During the follow-up period, there was no case of postoperative endophthalmitis, orbital dissemination, or local treatment failure. Three patients developed rhegmatogenous retinal detachment. Fourteen patients developed clinical evidence of metastasis. Of the 14 patients, 8 had monosomy 3 of the primary tumor, 2 had disomy 3, 1 had trisomy 3, and 3 had insufficient material for FISH. The cumulative 5-year Kaplan-Meier metastatic rate was 13%.
Transscleral FNAB at the time of iodine-125 plaque brachytherapy was not associated with endophthalmitis, orbital dissemination, or local treatment failure in this series, and post-brachytherapy retinal detachment occurred in 3 eyes. The cumulative Kaplan-Meier 5-year metastatic rate was not statistically different from the rate of 13% reported by the Collaborative Ocular Melanoma Study for tumors of the same size treated by brachytherapy without biopsy. Rhegmatogenous retinal detachment may occur in young patients secondary to posterior vitreous detachment induced by tumor response to radiation, unrelated to FNAB.
报告在进行碘 125 放射性敷贴治疗脉络膜黑色素瘤时行经巩膜术中细针抽吸活检（FNAB）的患者的局部和全身随访情况。
回顾性、单中心、连续病例队列研究。
共纳入 170 例接受碘 125 放射性敷贴治疗并行术中 FNAB 的脉络膜黑色素瘤连续患者。
所有患者均接受碘 125 放射性敷贴治疗，且于 2005 年 1 月至 2010 年 1 月期间在术中行 FNAB，并进行了至少 1 年的临床随访。
观察的结局包括眼内炎、眶内播散、局部治疗失败、孔源性视网膜脱离、单体型 3 状态和脉络膜黑色素瘤转移。
共纳入 170 例临床诊断为脉络膜黑色素瘤的连续患者，行术中 FNAB，并于碘 125 放射性敷贴治疗后进行了 1 至 6 年（平均 2.7±1.3 年）的随访。对于高度＜3.0mm、3.0 至 5.0mm 和＞5.0mm 的肿瘤，分别有 53%、68%和 91%的患者获得了足够的荧光原位杂交（FISH）活检材料。在随访期间，无术后眼内炎、眶内播散或局部治疗失败病例。3 例患者发生孔源性视网膜脱离。14 例患者出现临床转移证据。14 例患者中，8 例原发性肿瘤存在单体型 3，2 例存在二倍体 3，1 例存在三倍体 3，3 例 FISH 检测材料不足。累积 5 年 Kaplan-Meier 转移率为 13%。
在本研究中，经巩膜 FNAB 联合碘 125 放射性敷贴治疗并未导致眼内炎、眶内播散或局部治疗失败，且 3 只眼在治疗后发生视网膜脱离。累积 5 年 Kaplan-Meier 转移率与不进行活检而单纯行放射性敷贴治疗的相同大小肿瘤的协作性眼黑色素瘤研究报道的 13%的转移率无统计学差异。孔源性视网膜脱离可能继发于肿瘤对放射的反应导致的玻璃体后脱离，与 FNAB 无关，可发生于年轻患者。
