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

  • Qian Chen
  • Ruiqi Ma
  • Lu Gan
  • Hui Ren
  • Yifei YuanEmail author
Oculoplastics and Orbit



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.


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.


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.


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.


Ultrasound biomicroscopy Color Doppler flow imaging Lacrimal drainage system Medial canthus 



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.

Author 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.


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

Compliance with ethical standards

Conflict of interest

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.


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.


The views expressed in the manuscript are authors’ own and not an official position of the institution or funder.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Qian Chen
    • 1
  • Ruiqi Ma
    • 1
    • 2
    • 3
  • Lu Gan
    • 1
    • 2
    • 3
  • Hui Ren
    • 1
  • Yifei Yuan
    • 1
    Email author
  1. 1.Department of OphthalmologyFudan Eye and ENT HospitalShanghaiChina
  2. 2.NHC Key Laboratory of MyopiaFudan UniversityShanghaiChina
  3. 3.Laboratory of MyopiaChinese Academy of Medical SciencesShanghaiChina

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