Singaravelu Janani, Melendez-Moreno Alexander, Wrenn Jacquelyn, Singh Arun D
Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Ocul Oncol Pathol. 2023 Aug;9(1-2):9-16. doi: 10.1159/000529073. Epub 2023 Jan 13.
Determining the nature of iris melanocytic tumors based on clinical exam alone remains challenging. Tumor-associated vasculature of iris melanocytic lesions may facilitate the ability to discern between iris nevus and melanoma.
In a single-institution, retrospective, observational study of 45 patients with pathologically confirmed iris melanoma and 15 patients with iris nevi that were either clinically stable or pathologically confirmed were included. Tumor characteristics and associated vasculature were identified on clinical exam and slit-lamp photographs. Fluorescein angiographic parameters including feeder vessels, intrinsic vessels, leakage, masking, and angiographic silence were assessed.
Feeder vessels were present in 17 (43%) melanomas and were absent in the nevus group ( = 0.002). Thirty-three (83%) iris melanomas and 5 (33%) iris nevi were observed to have intrinsic vessels, and a statistically significant association of intrinsic vessels with malignancy ( = 0.001) was noted. Fluorescein leakage was also observed more frequently in iris melanoma 39 (98%) than in nevi 9 (60) with a significant difference ( = 0.001). Angiographic silence occurred in 3 nevi (20%) and was not observed in any melanoma ( = 0.017). Overall, the presence of intrinsic vessels +/- feeder vessels had high sensitivity (0.85) and high positive predictive value (0.87) for diagnosis of iris melanoma.
Anterior segment fluorescein angiography allows for the assessment of tumor-associated vascular patterns and demonstrates utility in differentiating iris nevi from melanoma. Feeder vessels were only observed in iris melanoma and were absent in iris nevi. The intrinsic vessels were present more frequently in melanomas and are thus associated with malignancy. Angiographic silence is indicative of iris nevi.
仅通过临床检查来确定虹膜黑素细胞肿瘤的性质仍然具有挑战性。虹膜黑素细胞病变的肿瘤相关脉管系统可能有助于区分虹膜痣和黑色素瘤。
在一项单机构回顾性观察研究中，纳入了45例经病理证实的虹膜黑色素瘤患者以及15例临床稳定或经病理证实的虹膜痣患者。通过临床检查和裂隙灯照片确定肿瘤特征及相关脉管系统。评估荧光素血管造影参数，包括供养血管、内部血管、渗漏、遮蔽和血管造影无显影。
17例（43%）黑色素瘤存在供养血管，而痣组未见供养血管（P = 0.002）。观察到33例（83%）虹膜黑色素瘤和5例（33%）虹膜痣有内部血管，且内部血管与恶性肿瘤之间存在统计学显著关联（P = 0.001）。虹膜黑色素瘤中荧光素渗漏也比痣更常见，分别为39例（98%）和9例（60%），差异有统计学意义（P = 0.001）。3例（20%）痣出现血管造影无显影，而黑色素瘤均未观察到（P = 0.017）。总体而言，内部血管±供养血管的存在对虹膜黑色素瘤诊断具有高敏感性（0.85）和高阳性预测值（0.87）。
前段荧光素血管造影可评估肿瘤相关血管模式，并在区分虹膜痣和黑色素瘤方面具有实用价值。供养血管仅在虹膜黑色素瘤中观察到，而虹膜痣中未见。内部血管在黑色素瘤中更常见，因此与恶性肿瘤相关。血管造影无显影提示虹膜痣。
