Abstract
Aims
The aim of this study is to assess the value of ultrasound in the differential diagnosis of orbital lesions.
Methods
One hundred and thirty-eight patients with clinical features of an orbital mass were examined by orbital ultrasound prior to undergoing surgery, from January 2000 to January 2017. All patients underwent excisional or incisional orbital biopsy. The results of orbital ultrasonography were compared with the final histological diagnosis.
Results
Orbital lesions were localized by ultrasonography in 133/138 cases (96.4%); the false-negative rate of orbital echography was 3.6% (5/138). The nature of the orbital lesions was correctly determined by ultrasonography in 54.3% of the cases (75/138) preoperatively (true positives). In 58/138 (42%) patients, there was no correspondence between the ultrasound diagnosis and the histological diagnosis (false positives). The sensitivity of orbital ultrasonography for the detection of an orbital mass was 93.75% (CI 87.87–99.63%), while the specificity yielded no meaningful result (CI 0.00–60.24%). Moreover, the specificity of orbital ultrasonography to identify a malignant tumor falls within a CI of 0–62.72%.
Conclusions
Orbital ultrasonography is a rapid and noninvasive test that is highly sensitive in displaying an orbital mass; however, the specificity in the differential diagnosis of orbital lesions is not meaningful, particularly if malignancy is suspected. The assessment of orbital diseases requires multiple diagnostic approaches to balance the strengths and weaknesses of each method.
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Data availability
The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
References
McQuown DS (1975) Ocular and orbital echography. Radiol Clin N Am 13:523–541
Ciocâlteu AM, Ardeleanu S, Checheriţă IA (2011) The role of US exam in orbital-ocular tumors. Rev Med Chir Soc Med Nat Iasi 115:1113–1118
Levine RA (1987) Orbital ultrasonography. Radiol Clin N Am 25:447–469
Gorospe L, Royo A, Berrocal T et al (2003) Imaging of orbital disorders in pediatric patients. Eur Radiol 13:2012–2026
Byrne SF (1984) Standardized echography in the differentiation of orbital lesions. Surv Ophthalmol 29:226–228
Spierer O, Neudorfer M, Leibovitch I et al (2012) Colour Doppler ultrasound imaging findings in paediatric periocular and orbital hemangiomas. Acta Ophthalmol 90:727–732
Ossoinig KC (1969) Orbital Ultrasonography. Schweiz Med Wochenschr 99(28):1033–1099
Cennamo G, Rosa N, Vallone G et al (1993) Echographic evaluation of the internal vascularity in orbital and eye tumors with a contrast agent. Echocardiography 19:682
Cennamo G, Rosa N, Vallone G, Smaltino F (1994) Evaluation of the internal vascularity in orbital and eye tumors with an echographic contrast agent. Ophthalmology 101:9A
Purohit BS, Vargas MI, Ailianou A et al (2016) Orbital tumours and tumour-like lesions: exploring the armamentarium of multiparametric imaging. Insights Imaging 7:43–68
Strianese D, Napoli M, Russo C et al (2014) Coexistence of cavernous hemangioma and other vascular malformations of the orbit A report of three cases. Neuroradiol J 27(2):223–231. https://doi.org/10.15274/NRJ-2014-10016
Ossoinig KC (1979) Standardized echography: basic principles, clinical applications, and results. Int Ophthalmol Clin 19(4):127–210
Harold Lee HB, Garrity JA, Cameron JD et al (2008) Primary optic nerve sheath meningioma in children. Surv Ophthalmol 53(6):543–558
Neudorfer M, Leibovitch I, Stolovitch C et al (2004) Intraorbital and periorbital tumors in children: value of ultrasound and color Doppler imaging in the differential diagnosis. Am J Ophthalmol 137:1065–1072
Chauhan S, Sen S, Sharma A et al (2014) American Joint Committee on Cancer Staging and clinicopathological high-risk predictors of ocular surface squamous neoplasia: a study from a tertiary eye center in India. Arch Pathol Lab Med 138(11):1488–1494
Ottaviano G, Cantone E, D'Errico A et al (2015) Sniffin' Sticks and olfactory system imaging in patients with Kallmann syndrome. Int Forum Allergy Rhinol 5(9):855–861
White-Gibson A, Lennon P, O'Regan E, Timon C (2019) More than meets the eye. BMJ Case Rep 12(2):e212000
Strianese D (2017) Update on Graves disease: advances in treatment of mild, moderate and severe thyroid eye disease. Curr Opin Ophthalmol 28(5):505–513
Comerci M, Elefante A, Strianese D et al (2013) Semiautomatic regional segmentation to measure orbital fat volumes in thyroid-associated ophthalmopathy A validation study. Neuroradiol J 26(4):373–379
Bingham CM, Sivak-Callcott JA, Gurka MJ et al (2016) Axial globe position measurement: a prospective multicenter study by the International Thyroid Eye Disease Society. Ophthalmic Plast Reconstr Surg 32(2):106–112
Tortora F, Prudente M, Cirillo M, Elefante A et al (2014) Diagnostic accuracy of short-time inversion recovery sequence in Graves' Ophthalmopathy before and after prednisone treatment. Neuroradiology 56(5):353–361
Cocozza S, Russo C, Pontillo G et al (2016) Is advanced neuroimaging for neuroradiologists? A systematic review of the scientific literature of the last decade. Neuroradiology 58(12):1233–1239
Strianese D, Piscopo R, Elefante A et al (2016) Unilateral proptosis in thyroid eye disease with subsequent contralateral involvement: retrospective follow-up study. BMC Ophthalmol 13:21
Mombaerts I, Bilyk JR, Rose GE et al (2017) For the Expert Panel of the Orbital Society Consensus on diagnostic criteria of idiopathic orbital inflammation using a modified delphi approach. JAMA Ophthalmol 135(7):769–776
Bertolotto M, Serafini G, Sconfienza LM et al (2014) The use of CEUS in the diagnosis of retinal/choroidal detachment and associated intraocular masses: preliminary investigation in patients with equivocal findings at conventional ultrasound. Ultraschall Med 35(2):173–180
Magliozzi P, Strianese D, Bonavolontà P et al (2015) Orbital metastases in Italy. Int J Ophthalmol 8(5):1018–1023
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Lanni, V., Iuliano, A., Fossataro, F. et al. The role of ultrasonography in differential diagnosis of orbital lesions. J Ultrasound 24, 35–40 (2021). https://doi.org/10.1007/s40477-020-00443-0
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DOI: https://doi.org/10.1007/s40477-020-00443-0