, Volume 23, Issue 7, pp 1919-1924
Date: 16 Feb 2013

Ultrasound-guided core-needle biopsy of extra-ocular orbital lesions

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To evaluate the diagnostic yield of ultrasound-guided core-needle biopsy of extra-ocular orbital lesions.


Fifty-five patients with monolateral exophthalmos prospectively underwent computed tomography (CT) to investigate the presence of an extra-ocular mass (n = 25). Excluding benign lesions (n = 7) and patients in whom CT revealed an unknown primitive malignancy (n = 5), 13 patients (7 male, 6 female; mean age 62 ± 16 years) underwent ultrasound. Lesion appearance (echotexture, power Doppler vascularisation), size, position with respect to the cone and to the globe were recorded. Ultrasound-guided biopsies were performed (automatic, n = 9; semi-automatic 18-G needle, n = 4). Sample adequacy and complication rate were recorded.


Ultrasound demonstrated hypoechoic lesions with mild power Doppler vascularity, that were completely (n = 7) or partially extra-conal (n = 6), located laterally (n = 8) or posteriorly (n = 5) to the globe. Mean size was 3.25 cm. All biopsies yielded adequate material for histological and immunohistochemical analysis (nine non-Hodgkin’s lymphomas, two adenocarcinomas, one lymphoid hyperplasia, one inflammatory pseudotumour). Complications included cutaneous eyelid haematoma (n = 3) and retro-bulbar haematoma (n = 1), treated conservatively and resolved at 10-day follow-up. No immediate or delayed vision reduction was reported.


Ultrasound-guided core-needle biopsy of extra-ocular orbital lesions is feasible and accurate, being free from long-term complications. This procedure provided 100 % adequate samples to achieve final diagnosis.

Key Points

• Ultrasound-guided core-needle biopsy of extra-ocular orbital lesions seems feasible and accurate.

• In this series it provided a final diagnosis in 13/13 cases.

• It appears free from long-term complications.

• It provides immunohistochemical analysis of the specimen.

• It should represent a valuable alternative to surgical biopsy.