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Multi-center analysis of intraocular biopsy technique and outcomes for uveal melanoma: Ocular Oncology Study Consortium report 4

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Abstract

Purpose

To investigate the relationship between surgical approach for intraocular tumor biopsy of uveal melanoma and tumor morphologic features such as size and intraocular location and the effect of these variables on diagnostic yield and biopsy outcome.

Methods

Consecutive patients from nine Ocular Oncology centers with uveal melanoma (UM) undergoing tumor biopsy immediately preceding I125 plaque brachytherapy with tissue sent for gene expression profiling (GEP) testing were reviewed retrospectively.

Results

Three hundred sixty patients were included (50% men, mean age 60.2 years). Overall biopsy yield was 99% and 83% for GEP and cytopathology, respectively. Surgeon choice of biopsy approach (trans-vitreal vs. trans-scleral) was found to associate with both tumor location and tumor thickness. A trans-scleral rather than trans-vitreal approach was used more commonly for anteriorly located tumors (92% vs. 38% of posterior tumors, p < 0.001) and thicker tumors (86% vs. 55% of thin tumors, p < 0.001). When performing trans-vitreal biopsies, ocular oncologists with previous vitreoretinal surgery fellowship training were more likely to use wide-field surgical viewing systems, compared with indirect ophthalmoscopy (82.6% vs. 20.6%, p < 0.001). Surgical complications were rare and occurred more frequently with trans-vitreal biopsies (3.6% vs. 0.46%, p = 0.046).

Conclusions

In this multi-center analysis of UM tumor biopsy, surgical yield was high for obtaining tumor tissue for GEP and cytopathology analysis with both trans-scleral and trans-vitreal techniques. Fellowship-trained ocular oncologists’ preferred intraocular biopsy techniques associated strongly with tumor location, tumor thickness, and fellowship training of the surgeon. Short-term complication rates were low.

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Acknowledgments

The following are Ocular Oncology Study Consortium members:

Duke Eye Center, Durham, NC (coordinating center): Prithvi Mruthyunjaya, MD, MHS (Study PI), Miguel Materin, MD, Michael I. Seider, MD, Duncan E. Berry, MD, Nikolas N. Raufi, MD, Sandra Stinnett, DrPH; University of Miami/Bascom Palmer Eye Institute, Miami, FL: J. William Harbour, MD; University of Southern California/USC Roski Eye Institute, Los Angeles, CA: Jesse L. Berry, MD, and Jonathan Kim, MD; Oregon Health Sciences/Casey Eye Institute, Portland, OR: Alison Skalet, MD, PhD, and Audra Miller, MD; Smilow Cancer Hospital at Yale New Haven, New Haven, CT: Miguel Materin, MD, and Tiffany Liu, MD; University of Michigan, Ann Arbor, MI: Hakan Demirci, MD, and Zeynep G. Ozkurt, MD; Colorado Retina Associates, Rocky Vista University, Denver, CO: Peter Hovland, MD, PhD; Retina Specialists of Michigan, Grand Rapids, MI and Michigan State University, East Lansing, MI: Thomas Aaberg, Jr., MD; Retina Consultants of Houston/Blanton Eye Institute at Houston Methodist Hospital, Houston TX: Amy C. Schefler, MD, Ryan S. Kim, and Anne Tann, MD (Department of Radiation Oncology, Houston Methodist Hospital).

Funding

This study was funded by The Heed Ophthalmic Fellowship - (M.Seider), The Childress Family Foundation (NC), unrestricted departmental funding from Research to Prevent Blindness (New York, NY) and by grant P30 EY010572 from the National Institutes of Health (Bethesda, MD) – (P.Mruthyunjaya).

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Correspondence to Prithvi Mruthyunjaya.

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Conflict of interest

Prithvi Mruthyunjaya serves as a consultant for Castle Biosciences, Optos Inc., Santen, EyePoint Pharmaceuticals, and Arix Biosciences.

Miguel Materin serves as a consultant for Castle Biosciences.

Amy Schefler serves as a consultant for Castle Biosciences (grant funding), Aura Biosciences (consultant, grant funding); Regeneron (grant funding) and Genentech (consultant, grant funding).

Duncan Berry declares he has no conflict of interest.

Michael I. Seider declares he has no conflict of interest.

Sandra Stinnett declares she has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the numerous Institutional Review Boards who reviewed this study (all centers listed below) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was not obtained from all individual participants included in the study as this study was retrospective and de-identified.

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The design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication were solely made by the authors without influence from the funding organizations.

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Seider, M.I., Berry, D.E., Schefler, A.C. et al. Multi-center analysis of intraocular biopsy technique and outcomes for uveal melanoma: Ocular Oncology Study Consortium report 4. Graefes Arch Clin Exp Ophthalmol 258, 427–435 (2020). https://doi.org/10.1007/s00417-019-04531-8

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