Tang Audrey, Ng Helen Hoi-Lam, Gout Taras, Chang Bernard, El-Hindy Nabil, Kalantzis George
School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, LS2.9 JT, United Kingdom.
Department of Ophthalmology, St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, United Kingdom.
Int J Ophthalmol. 2023 Apr 18;16(4):616-622. doi: 10.18240/ijo.2023.04.16. eCollection 2023.
To assess the concordance between diagnosing orbital lesions by clinical examination, orbital imaging, and histological evaluation, in order to help guide future research and clinical practice.
A retrospective analysis was undertaken at a large regional tertiary referral centre of all surgical orbital biopsies performed over a 5-year period, from 1 January 2015 until 31 December 2019. Accuracy and concordance between clinical, radiological and histological diagnoses are reported as percentage sensitivity and positive predictive value.
A total of 128 operations involving 111 patients were identified. Overall, sensitivities of 47.7% for clinical and 37.3% for radiological diagnoses were found when compared to the histological gold standard. Vascular lesions that have characteristic clinical and radiological features had the highest sensitivity at 71.4% and 57.1%, respectively. Inflammatory conditions showed the lowest sensitivity in both clinical (30.3%) and radiological (18.2%) diagnoses. The PPV for inflammatory conditions were 47.6% for clinical and 30.0% for radiological diagnoses.
Accurate diagnoses are difficult to reach by relying on clinical examination and imaging alone. Surgical orbital biopsy with histological diagnosis should remain the gold standard approach for definitively identifying orbital lesions. Although larger scale prospective studies would help further refine concordance and guide future research avenues.
评估通过临床检查、眼眶成像和组织学评估诊断眼眶病变之间的一致性，以帮助指导未来的研究和临床实践。
在一个大型区域三级转诊中心对2015年1月1日至2019年12月31日这5年期间进行的所有眼眶手术活检进行回顾性分析。临床、放射学和组织学诊断之间的准确性和一致性以百分比敏感性和阳性预测值报告。
共确定了涉及111名患者的128例手术。总体而言，与组织学金标准相比，临床诊断的敏感性为47.7%，放射学诊断的敏感性为37.3%。具有特征性临床和放射学特征的血管病变敏感性最高，分别为71.4%和57.1%。炎症性疾病在临床（30.3%）和放射学（18.2%）诊断中敏感性最低。炎症性疾病的临床诊断阳性预测值为47.6%，放射学诊断阳性预测值为30.0%。
仅依靠临床检查和影像学很难做出准确诊断。眼眶手术活检及组织学诊断仍应是明确识别眼眶病变的金标准方法。尽管更大规模的前瞻性研究将有助于进一步完善一致性并指导未来的研究方向。
