Klingenstein Annemarie, Schaumberger Markus M, Freeman William R, Folberg Robert, Mueller Arthur J, Schaller Ulrich C
Department of Ophthalmology, Ludwig-Maximilians University, Munich, Germany.
Shiley Eye Center, San Diego, CA, USA.
Acta Ophthalmol. 2016 Mar;94(2):175-81. doi: 10.1111/aos.12836. Epub 2015 Oct 1.
To statistically determine differences in microcirculation patterns between nevi and uveal melanomas and the influence of these patterns on metastatic potential in the long-term follow-up of 112 patients with melanocytic uveal tumours. In vivo markers indicating malignancy and metastatic potential have implications for treatment decision.
Primary diagnosis and work-up included clinical examination, fundus photography, standardized A and B scan echography as well as evaluation of tumour microcirculation patterns via confocal fluorescein and indocyanine green angiography (ICGA). Patient data were collected from the patient files, the tumour registry or personal contact. Statistical analysis was performed with spss 22.0 using chi-square, Fisher's exact test and Kaplan-Meier survival analysis.
Forty-three uveal melanocytic lesions remained untreated and were retrospectively classified as benign nevi, whereas 69 lesions were malignant melanomas (T1: 32, T2: 28, T3: 6 and T4: 3). 'Silent' and 'arcs without branching' were found significantly more often in nevi (p = 0.001 and p = 0.010), whereas 'parallel with cross-linking' and 'networks' were significantly more frequent in melanomas (p = 0.022 and p = 0.029). The microcirculation pattern 'parallel with cross-linking' proved significantly more frequent in patients who developed metastases (p = 0.001).
Certain microcirculation patterns may guide us in differentiating uveal nevi from malignant melanomas. A non-invasive prognostic marker can be of great value for borderline lesions in which cytology is less likely taken. 'Parallel with cross-linking' did not only indicate malignancy, but it was also associated with later tumour metastasis.
通过对112例葡萄膜黑素细胞瘤患者的长期随访，统计分析痣和葡萄膜黑色素瘤的微循环模式差异，以及这些模式对转移潜能的影响。指示恶性肿瘤和转移潜能的体内标志物对治疗决策具有重要意义。
初步诊断和检查包括临床检查、眼底摄影、标准化A和B扫描超声检查，以及通过共聚焦荧光素和吲哚菁绿血管造影（ICGA）评估肿瘤微循环模式。患者数据从患者病历、肿瘤登记处或个人联系中收集。使用SPSS 22.0进行统计学分析，采用卡方检验、Fisher精确检验和Kaplan-Meier生存分析。
43例葡萄膜黑素细胞病变未接受治疗，回顾性分类为良性痣，而69例病变为恶性黑色素瘤（T1：32例，T2：28例，T3：6例，T4：3例）。“无声”和“无分支的弧形”在痣中更常见（p = 0.001和p = 0.010），而“平行交叉”和“网络状”在黑色素瘤中更常见（p = 0.022和p = 0.029）。在发生转移的患者中，“平行交叉”的微循环模式明显更常见（p = 0.001）。
某些微循环模式可能有助于我们区分葡萄膜痣和恶性黑色素瘤。对于难以进行细胞学检查的临界病变，非侵入性预后标志物可能具有重要价值。“平行交叉”不仅表明恶性肿瘤，还与肿瘤后期转移有关。
