Ching Jared, AlHarby Lamis, Sagoo Mandeep S, Damato Bertil
Ocular Oncology Service, Moorfields Eye Hospital, London, UK.
John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK.
Ocul Oncol Pathol. 2023 Aug;9(1-2):40-47. doi: 10.1159/000529862. Epub 2023 Apr 10.
It can be challenging to distinguish between choroidal naevi and melanomas in the community setting, particularly without access to ultrasonography (US), required to measure the thickness of melanocytic choroidal tumours. We aimed to determine whether thickness measurement is required for MOLES scoring of melanocytic choroidal tumours.
The dataset of a recent MOLES evaluation was reviewed. Patients were selected for the present study if their MOLES tumour size category was determined by tumour thickness measured with US. The largest basal tumour diameter and tumour thickness were then measured from ultra-widefield fundus images and optical coherence tomography (OCT) images, respectively.
The tumour size category was determined by tumour diameter in 203/222 (91.4%) with no influence of tumour thickness. The tumour thickness influenced the MOLES score in 19/222 (8.6%) patients. In 11/19 patients with OCT measurements of tumour thickness, the US measurement exceeded the OCT by more than 25% in 5 patients, more than 50% in 2 patients, and more than 75% in 1 patient. As a result, the revised tumour thickness based on OCT determined the size category in 4/216 (1.8%) patients. The ultra-widefield fundus images measurements increased the diameter score by 1 in 5 patients. As a result, the revised tumour thickness determined the size category in 4/216 (1.8%) patients. If both the revised diameter and thickness scores were considered, the MOLES score reduced in 4 patients. If both the diameter and thickness scores were considered, the MOLES score reduced in 5 and increased in 1. Only 0.94% (2/211) of melanocytic choroidal tumours assessed with MOLES when using Optos ultra-widefield fundus images diameter and OCT to measure tumour diameter and thickness, respectively, required a change in management from a reduction in MOLES score from 1 to 0.
DISCUSSION/CONCLUSION: This study suggests that the MOLES category for size is influenced more by the tumour diameter, if it can be measured accurately, than by the thickness. This study suggests ignoring tumour thickness if this cannot be measured accurately with OCT, unless the tumour has a mushroom shape.
在社区环境中，区分脉络膜痣和黑色素瘤可能具有挑战性，尤其是在无法进行超声检查（US）的情况下，而超声检查是测量脉络膜黑色素细胞肿瘤厚度所必需的。我们旨在确定脉络膜黑色素细胞肿瘤的MOLES评分是否需要进行厚度测量。
回顾了最近一次MOLES评估的数据集。如果患者的MOLES肿瘤大小类别是通过超声测量的肿瘤厚度确定的，则将其纳入本研究。然后分别从超广角眼底图像和光学相干断层扫描（OCT）图像中测量最大基底肿瘤直径和肿瘤厚度。
203/222例（91.4%）患者的肿瘤大小类别由肿瘤直径决定，不受肿瘤厚度影响。19/222例（8.6%）患者的肿瘤厚度影响MOLES评分。在11/19例有OCT测量肿瘤厚度的患者中，超声测量值比OCT测量值超出25%以上的有5例，超出50%以上的有2例，超出75%以上的有1例。因此，基于OCT的修正肿瘤厚度在4/216例（1.8%）患者中决定了大小类别。超广角眼底图像测量使5例患者的直径评分提高了1分。结果，修正后的肿瘤厚度在4/216例（1.8%）患者中决定了大小类别。如果同时考虑修正后的直径和厚度评分，4例患者的MOLES评分降低。如果同时考虑直径和厚度评分，5例患者的MOLES评分降低，1例患者的MOLES评分升高。当分别使用Optos超广角眼底图像直径和OCT测量肿瘤直径和厚度时，用MOLES评估的脉络膜黑色素细胞肿瘤中只有0.94%（2/211）需要将MOLES评分从1降至0来改变治疗方案。
讨论/结论：本研究表明，如果能够准确测量，MOLES大小类别受肿瘤直径的影响大于受厚度的影响。本研究表明，如果无法用OCT准确测量肿瘤厚度，则忽略肿瘤厚度，除非肿瘤呈蘑菇状。
