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Value of ultrasound biomicroscopy in assessment of small masses at medial canthal region

  • Oculoplastics and Orbit
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Abstract

Purpose

Conventional imaging techniques are not sensitive enough to reveal detailed structures of lacrimal drainage system (LDS) and its surrounding tissue (ST). Our study aimed to explore utility of ultrasound biomicroscopy (UBM) in assessment of small masses at the medial canthal region and compare performance of UBM with conventional imaging techniques.

Methods

We prospectively recruited cases with small mass (long axis < 1 cm) at the medial canthal region (upper LDS-located area) from June 2017 to October 2018. UBM ± color Doppler flow imaging (CDFI) and conventional imaging techniques (computed tomography, magnetic resonance imaging, and dacryocystography) were conducted by four independent practitioners. Results were analyzed against gold standards with Cohen’s kappa test in three aspects including LDS patency, mass location, and presumptive diagnosis. Corresponding gold standards were syringe and dacryocystography, intraoperative findings, and pathological/empirical diagnosis.

Results

Seventy-two cases were recruited, including 20 cases of LDS lesions and 52 cases of ST lesions. Female (odds ratio 7.14) and age ≥ 37 (odds ratio 9.80) were risk factors for LDS lesion, and age range of 15–25 (odds ratio 9.17) was a risk factor for inflammatory ST lesion. In terms of LDS patency, UBM results were reliable for the detection of pre-saccal obstruction (kappa = 0.920), but were not reliable for intra-saccal and post-saccal obstruction (kappa = 0.106). In terms of mass location, the UBM (kappa = 0.766) performed better than conventional techniques (except for dacryocystography) to sort out ST lesions, with sensitivity of 93.8% and specificity of 83.3%. In terms of diagnosis, the UBM (kappa = 0.882) outweighed conventional techniques (except for magnetic resonance imaging) to distinguish cysts from nodules, with sensitivity of 93.8% and specificity of 94.4%. Notably, the UBM + CDFI achieved better performance than the UBM when screen out inflammatory lesions (kappa = 0.926 vs kappa = 0.689) and LDS-adjacent lesions (kappa = 0.815 vs kappa = 0.673), resulting in sensitivity of 91.7% and specificity of 100% for both testing items. If deep lesions (at the lacrimal sac–harbored area) were excluded, UBM reliability to detect inflammatory lesions (kappa = 0.915) and LDS-adjacent lesions (kappa = 0.770) improved, achieving sensitivity of 90.0% and 88.9%, and specificity of 100.0% and 92.7%, respectively.

Conclusions

The UBM is a valuable tool to assess superficial masses at the medial canthal region regarding pre-saccal obstruction, mass location, and presumptive diagnosis.

Trial registration

This work was registered on Chinese Clinical Trial Registry website with registration number ChiCTR1800018956.

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Acknowledgements

We gratefully acknowledge Dr. Yue Geng (Fudan Eye & ENT Hospital) for performing DCG imaging, Dr. Yichen Li (Fudan Eye & ENT Hospital) for performing CT scan, and Dr. Shenjiang Wang (Fudan Eye & ENT Hospital) for performing MRI scan.

Funding

This work was supported by National Natural Science Foundation of China (grant number 81800867).

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Author notes

  1. Qian Chen and Ruiqi Ma contributed equally to this work.

Authors and Affiliations

  1. Department of Ophthalmology, Fudan Eye and ENT Hospital, 83 Fen Yang Road, Xuhui District, Shanghai, 200031, China

    Qian Chen, Ruiqi Ma, Lu Gan, Hui Ren & Yifei Yuan

  2. NHC Key Laboratory of Myopia, Fudan University, Shanghai, China

    Ruiqi Ma & Lu Gan

  3. Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China

    Ruiqi Ma & Lu Gan

Authors
  1. Qian Chen
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Contributions

Q.C., R.M., and Y.Y. conceived and designed research; H.R. served as scientific advisor; Y.Y. critically reviewed the study proposal; Q.C. and R.M. collected and analyzed the data; L.G. provided and cared for study patients; R.M. drafted the manuscript; Q.C., L.G., H.R. and Y.Y. edited and revised the manuscript; Q.C., R.M., L.G., H.R., and Y.Y. approved final version of the manuscript.

Corresponding author

Correspondence to Yifei Yuan.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Declaration

Authors declare no financial relationship with the organization that sponsored the research. Authors have full control of all primary data and agree to allow Graefes Archive for Clinical and Experimental Ophthalmology to review the primary data upon request.

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Chen, Q., Ma, R., Gan, L. et al. Value of ultrasound biomicroscopy in assessment of small masses at medial canthal region. Graefes Arch Clin Exp Ophthalmol 257, 827–834 (2019). https://doi.org/10.1007/s00417-019-04252-y

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  • DOI: https://doi.org/10.1007/s00417-019-04252-y

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