Surgical Technique, Indications, and Outcomes of BIOM-Assisted Transvitreal Biopsy for Uveal Melanoma.
Surgical Technique, Indications, and Outcomes of BIOM-Assisted Transvitreal Biopsy for Uveal Melanoma.
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DOI：
10.1097/iae.0000000000002677
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发表时间：
2022-11-01
期刊：
影响因子：
--
通讯作者：
Daniels AB
中科院分区：
文献类型：
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作者：
Snyder LL;Daniels AB
关于葡萄膜黑色素瘤 (UM) 活检的最佳方法存在争议。我们描述了我们的经玻璃体技术，并评估了该技术的安全性以及获取样本进行预后基因分析的有效性。手术技术和回顾性病例系列的描述。对使用我们描述的技术进行经玻璃体活检的 UM 患者的医疗记录进行了肿瘤大小、位置、主要治疗、活检方法及其任何并发症的分析。记录接受经玻璃体活检的肿瘤特征，包括肿瘤大小、位置或视网膜下液的存在，以了解这些是否影响外科医生对活检方式的偏好。一组通过经巩膜技术接受活检的同期 UM 患者作为这些患者、肿瘤和并发症因素的比较组。 2013 年至 2016 年间，共有 27 名年龄在 27.2-88.6 岁（平均 64.8 岁）的患者使用我们描述的技术接受了经玻璃体活检。诊断时有 15 个小肿瘤、10 个中肿瘤和 2 个大肿瘤，其中大多数 (n=17) 位于赤道后方。术中并发症包括 20 名患者（74.1%）在活检部位出现凝块或小滴血，8 名患者（29.6%）出现局部视网膜下少量出血，4 名患者（14.8%）出现少量玻璃体出血，以及 1 名患者（3.6%）出现短暂性脉络膜小脱离。当视网膜下出血发生时，它几乎总是进入预先存在的视网膜下液袋中（p=0.0093）。然而，视网膜下液的存在与进行任何活检（p=0.36）或经玻璃体活检（p=1.00）的决定无关。 3 个月后，基本上所有病例的视网膜下和/或玻璃体出血均得到缓解。在平均 41.7 个月（范围：20-62.1）个月的随访中，没有出现医源性视网膜脱离或眼外肿瘤扩散的病例。从每次活检中获得足够的组织用于基因表达谱分析。接受经巩膜活检的比较组患者包括 20 名患者的 21 个 UM（一只眼睛有 2 个黑色素瘤）。与同期接受经巩膜活检的患者相比，经玻璃体活检在小肿瘤（n=15；p<0.0001）、后肿瘤（n=17；p<0.0001）患者中更为常见。该技术可用于小型或后部肿瘤，或用于经巩膜入路有肿瘤穿孔风险的小型前部肿瘤。并发症轻微、短暂且具有自限性。在所有病例中，分子预后的活检产量均足够。视网膜下液的存在可能被认为是相对禁忌症，因为它可能导致液袋中的视网膜下出血，但并没有阻止我们对可以从中受益的患者使用这种经玻璃体技术。我们描述了一种使用 BIOM 系统对葡萄膜黑色素瘤进行活检的技术，该技术可以实现出色的可视化和控制。进行的所有操作都是为了最大限度地减少经玻璃体肿瘤活检的已知并发症。我们纳入了在我们机构接受活检的前 27 名患者的数据。
Controversy exists regarding the best method for biopsy of uveal melanoma (UM). We describe our transvitreal technique, and evaluate the safety of this technique as well as the efficacy for obtaining sample for prognostic genetic profiling. Description of surgical technique and retrospective case series. Medical records for UM patients who underwent transvitreal biopsy using our described technique were analyzed for tumor size, location, primary treatment, method of biopsy and any complications thereof. Characteristics of tumors that underwent transvitreal biopsy were noted including tumor size, location, or presence of subretinal fluid, to see if these affected surgeon preference for biopsy modality. A cohort of contemporaneous UM patients who underwent biopsy via a transscleral technique served as a comparator group for these patient, tumor, and complication factors. A total of 27 patients aged 27.2–88.6 years (mean 64.8) underwent transvitreal biopsy using our described technique between 2013–2016. There were 15 small, 10 medium, and 2 large tumors at diagnosis with the majority (n=17) posterior to the equator. Intraoperative complications included a clot or small trickle of blood at the biopsy site in 20 (74.1%) of patients, small localized subretinal hemorrhage in 8 (29.6%), small vitreous hemorrhage in 4 (14.8%), and small transient choroidal detachments in 1 patient (3.6%). When subretinal hemorrhage occurred, it was almost always into a pre-existing pocket of subretinal fluid (p=0.0093). However, the presence of subretinal fluid was not associated with the decision to proceed with any biopsy (p=0.36) or transvitreal biopsy specifically (p=1.00). By 3 months, subretinal and/or vitreous hemorrhage resolved in essentially all cases. There were no cases of iatrogenic retinal detachment or extraocular tumor spread over a mean follow-up of 41.7 (range: 20–62.1) months. Adequate tissue for gene expression profiling was obtained from each biopsy. The comparator group of patients undergoing transscleral biopsy including 21 UMs in 20 patients (one eye had 2 melanomas). Transvitreal biopsies were more common in patients with small (n=15; p<0.0001), posterior (n=17; p<0.0001) tumors, compared to patients who underwent transscleral biopsy during the same period. This technique can be used for small or posterior tumors, or for small anterior tumors where a transscleral approach would risk tumor perforation. Complications were minor, transient, and self-limited. Biopsy yields for molecular prognosis were adequate in all cases. The presence of subretinal fluid may be considered a relative contraindication, because it may lead to subretinal hemorrhage in the fluid pocket, but did not dissuade us from utilizing this transvitreal technique for patients who would benefit from it. We describe a technique for biopsy of uveal melanomas using the BIOM system, which allows for excellent visualization and control. All of the manipulations performed are geared toward minimizing the known complications of transvitreal tumor biopsy. We include data from the first 27 patients who underwent biopsy at our institution.
影响因子：
2.3
作者：
Schopper VJ;Correa ZM
通讯作者：
Correa ZM