Abstract
Biopsy involves the removal of a tissue sample, laboratory analysis, and interpretation of the results. The usual objective of biopsy has been to establish or confirm a diagnosis. For example, intraocular biopsy is useful when clinical examination fails to distinguish a melanoma from a nevus or metastasis. Even when there is a confident clinical diagnosis, biopsy may be performed to determine the tumor subtype. A uveal tumor can be sampled by aspirational, incisional, or excisional biopsy techniques, depending on its size and location in the eye. Close collaboration with the cytopathologist is essential to ensure adequate sample size and handling. Aspiration biopsy is essentially contraindicated if retinoblastoma is a possibility. In this chapter, we review techniques, indications, complications, and the limitations of intraocular biopsies. Techniques for biopsy of conjunctival, eyelid, and orbital tumors are covered elsewhere in their respective volumes.
Other biopsy techniques such as incisional and excisional biopsy and diagnostic vitrectomy are discussed elsewhere.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Long SR, Cohen MB. Classics in cytology VII: Kun, Lebert, and early efforts at fine-needle aspiration biopsy. Diagn Cytopathol. 1996;14(2):182–3.
Webb AJ. Early microscopy: history of fine needle aspiration (FNA) with particular reference to goitres. Cytopathology. 2001;12(1):1–6.
Ansari NA, Derias NW. Fine needle aspiration cytology. J Clin Pathol. 1997;50(7):541–3.
Rosa M. Fine-needle aspiration biopsy: a historical overview. Diagn Cytopathol. 2008;36(11):773–5.
Frable WJ. Fine-needle aspiration biopsy: a review. Hum Pathol. 1983;14(1):9–28.
Hajdu SI, Ehya H. Foundation of diagnostic cytology. Ann Clin Lab Sci. 2008;38(3):296–9.
Veasey CA Jr. Intraocular biopsy. Am J Ophthalmol. 1951;34(3):432–4.
Long JC, Black WC, Danielson RW. Aspiration biopsy in intraocular tumors. AMA Arch Ophthalmol. 1953;50(3):303–10.
Jensen OA, Andersen SR. Late complications of biopsy in intraocular tumors. Acta Ophthalmol. 1959;37:568–75.
Takemura T, Tomatsu Y. Studies on malignant melanoma of the choroid. I. Needle biopsy, light microscopy, and electron microscopy. Nippon Ganka Gakkai Zasshi. 1967;71(8):1317–22.
Makley TA, Jr. Biopsy of intraocular lesions. Am J Ophthalmol 1967;64(3):Suppl:591–9.
Sagiroglu N, Ozgonul T, Muderris S. Diagnostic intraocular cytology. Acta Cytol. 1975;19(1):32–7.
Grgic Z, Ljustina-Ivancic N. Cytomorphologic findings in the diagnosis of intraocular lymphocytic tumors (author’s transl). Klinische Monatsblatter fur Augenheilkunde. 1978;173(3):416–8.
Jakobiec FA, Coleman DJ, Chattock A, et al. Ultrasonically guided needle biopsy and cytologic diagnosis of solid intraocular tumors. Ophthalmology. 1979;86(9):1662–81.
Augsburger JJ, Shields JA, Folberg R, et al. Fine needle aspiration biopsy in the diagnosis of intraocular cancer. Cytologic-histologic correlations. Ophthalmology. 1985;92(1):39–49.
Char DH, Kemlitz AE, Miller T, et al. Iris ring melanoma: fine needle biopsy. Br J Ophthalmol. 2006;90(4):420–2.
Char DH, Miller TR, Ljung BM, et al. Fine needle aspiration biopsy in uveal melanoma. Acta Cytol. 1989;33(5):599–605.
Davila RM, Miranda MC, Smith ME. Role of cytopathology in the diagnosis of ocular malignancies. Acta Cytol. 1998;42(2):362–6.
Eide N, Syrdalen P, Walaas L, et al. Fine needle aspiration biopsy in selecting treatment for inconclusive intraocular disease. Acta Ophthalmol Scand. 1999;77(4):448–52.
Faulkner-Jones BE, Foster WJ, Harbour JW, et al. Fine needle aspiration biopsy with adjunct immunohistochemistry in intraocular tumor management. Acta Cytol. 2005;49(3):297–308.
Shields CL, Manquez ME, Ehya H, et al. Fine-needle aspiration biopsy of iris tumors in 100 consecutive cases: technique and complications. Ophthalmology. 2006;113(11):2080–6.
Shields JA, Shields CL, Ehya H, et al. Fine-needle aspiration biopsy of suspected intraocular tumors. The 1992 Urwick Lecture. Ophthalmology. 1993;100(11):1677–84.
Correa ZM, Augsburger JJ. Sufficiency of FNAB aspirates of posterior uveal melanoma for cytologic versus GEP classification in 159 patients, and relative prognostic significance of these classifications. Graefes Arch Clin Exp Ophthalmol. 2014;252(1):131–5.
Sellam A, Desjardins L, Barnhill R, et al. Fine Needle Aspiration Biopsy in Uveal Melanoma: Technique, Complications, and Outcomes. Am J Ophthalmol. 2016;162:28–34. e1.
Shields CL, Ganguly A, Materin MA, et al. Chromosome 3 analysis of uveal melanoma using fine-needle aspiration biopsy at the time of plaque radiotherapy in 140 consecutive cases: the Deborah Iverson, MD, Lectureship. Arch Ophthalmol. 2007;125(8):1017–24.
Shields CL, Say EAT, Hasanreisoglu M, et al. Personalized prognosis of uveal melanoma based on cytogenetic profile in 1059 patients over an 8-year period: the 2017 Harry S. Gradle Lecture. Ophthalmology. 2017;124(10):1523–31.
Singh AD, Medina CA, Singh N, et al. Fine-needle aspiration biopsy of uveal melanoma: outcomes and complications. Br J Ophthalmol. 2016;100(4):456–62.
Fastenberg DM, Finger PT, Chess Q, et al. Vitrectomy retinotomy aspiration biopsy of choroidal tumors. Am J Ophthalmol. 1990;110(4):361–5.
Arbour JD, Mukai S. Biopsy of the retina and the choroid. Int Ophthalmol Clin. 1999;39(1):213–22.
Foulds WS. The uses and limitations of intraocular biopsy. Eye. 1992;6(Pt 1):11–27.
Bechrakis NE, Foerster MH, Bornfeld N. Biopsy in indeterminate intraocular tumors. Ophthalmology. 2002;109(2):235–42.
Kvanta A, Seregard S, Kopp ED, et al. Choroidal biopsies for intraocular tumors of indeterminate origin. Am J Ophthalmol. 2005;140(6):1002–6.
Sen J, Groenewald C, Hiscott PS, et al. Transretinal choroidal tumor biopsy with a 25-gauge vitrector. Ophthalmology. 2006;113(6):1028–31.
Char DH. Intraocular biopsy. In: Singh AD, Damato BE, Pe’er J, et al., editors. Clinical ophthalmic oncology. Philadelphia: Saunders-Elsevier; 2007.
Green WR. Diagnostic cytopathology of ocular fluid specimens. Ophthalmology. 1984;91(6):726–49.
Augsburger JJ, Shields JA. Fine needle aspiration biopsy of solid intraocular tumors: indications, instrumentation and techniques. Ophthalmic Surg. 1984;15(1):34–40.
Eide N, Walaas L. Fine-needle aspiration biopsy and other biopsies in suspected intraocular malignant disease: a review. Acta Ophthalmol. 2009;87(6):588–601.
Singh AD, Pelayes DE, Brainard JA, et al. History, indications, techniques and limitations. Monogr Clin Cytol. 2012;21:1–9.
Pelayes DE, Zarate JO, Biscotti CV, et al. Calibrated needle for ophthalmic fine needle aspiration biopsy. Br J Ophthalmol. 2012;96(8):1147–8.
Young TA, Burgess BL, Rao NP, et al. Transscleral fine-needle aspiration biopsy of macular choroidal melanoma. Am J Ophthalmol. 2008;145(2):297–302.
Singh AD, Pelayes D, Zarate JO, et al. FNAB of uveal melanoma with a graded prototype needle. ARVO Meet Abstr. 2011;52(6):3270.
Grossniklaus HE. Fine-needle aspiration biopsy of the iris. Arch Ophthalmol. 1992;110(7):969–76.
Singh AD, Aziz HA, Pelayes D, et al. Twenty-five-gauge cannula-assisted fine-needle aspiration biopsy of choroidal melanoma: cytopathological analysis. Retina. 2017;37(9):1674–7.
Brainard JA, Biscotti CV. Cytological preparation. Monogr Clin Cytol. 2012;21:10–6.
Pelayes DE, Zarate JO. Fine needle aspiration biopsy with liquid-based cytology and adjunct immunohistochemistry in intraocular melanocytic tumors. Eur J Ophthalmol. 2010;20(6):1059–65.
Augsburger JJ, Correa ZM. Taxonomy of intraocular tumor biopsies. Implications for reporting and comparison of results. IOVS 2012;53:ARVO E-Abstract 3397 2012.
Seregard S. To biopsy or not to biopsy? Acta Ophthalmol. 2009;87(6):586–7.
Turell ME, Tubbs RR, Biscotti CV, et al. Uveal melanoma: prognostication. Monogr Clin Cytol. 2012;21:55–60.
Alzahrani YA, Aziz HA, Shrestha NK, et al. Cryptococcal iridociliary granuloma. Surv Ophthalmol. 2016;61(4):498–501.
Bianchi JI, Graue EF, Lopez-Rubio S, et al. Diagnostic and therapeutic challenges. Retina. 2018; https://doi.org/10.1097/IAE.0000000000002190. PMID 29864073.
Augsburger JJ, Correa ZM, Schneider S, et al. Diagnostic transvitreal fine-needle aspiration biopsy of small melanocytic choroidal tumors in nevus versus melanoma category. Trans Am Ophthalmol Soc. 2002;100:225–32. discussion 32-4.
Ylagan LR. Intraocular pigmented proliferations in the context of cytologic evaluation. Diagn Cytopathol. 2009;37(11):853–64.
Cohen VM, Dinakaran S, Parsons MA, et al. Transvitreal fine needle aspiration biopsy: the influence of intraocular lesion size on diagnostic biopsy result. Eye (Lond). 2001;15(Pt 2):143–7.
Augsburger JJ. Fine needle aspiration biopsy of suspected metastatic cancers to the posterior uvea. Trans Am Ophthalmol Soc. 1988;86:499–560.
Biscotti CV, Singh AD. Uveal melanoma: diagnostic features. Monogr Clin Cytol. 2012;21:44–54.
Medina CA, Biscotti CV, Singh N, et al. Diagnostic cytologic features of uveal melanoma. Ophthalmology. 2015;122(8):1580–4.
Shields CL, Shields JA, Gross NE, et al. Survey of 520 eyes with uveal metastases. Ophthalmology. 1997;104(8):1265–76.
Trichopoulos N, Augsburger JJ. Neuroendocrine tumours metastatic to the uvea: diagnosis by fine needle aspiration biopsy. Graefes Arch Clin Exp Ophthalmol. 2006;244(4):524–8.
Char DH, Ljung BM, Deschenes J, et al. Intraocular lymphoma: immunological and cytological analysis. Br J Ophthalmol. 1988;72(12):905–11.
Davis JL, Solomon D, Nussenblatt RB, et al. Immunocytochemical staining of vitreous cells. Indications, techniques, and results. Ophthalmology. 1992;99(2):250–6.
Davis JL, Viciana AL, Ruiz P. Diagnosis of intraocular lymphoma by flow cytometry. Am J Ophthalmol. 1997;124(3):362–72.
Farkas T, Harbour JW, Davila RM. Cytologic diagnosis of intraocular lymphoma in vitreous aspirates. Acta Cytol. 2004;48(4):487–91.
Karcioglu ZA. Fine needle aspiration biopsy (FNAB) for retinoblastoma. Retina. 2002;22(6):707–10.
Ali MJ, Honavar SG, Vemuganti GK. Ciliary body medulloepithelioma in an adult. Surv Ophthalmol. 2013;58(3):266–72.
Singh AD, Soto H, Bellerive C, et al. Reactive retinal astrocytic tumor (focal nodular gliosis): report of the clinical spectrum of 3 cases. Ocul Oncol Pathol. 2017;3(3):235–9.
Munier FL, Gaillard MC, Balmer A, et al. Intravitreal chemotherapy for vitreous disease in retinoblastoma revisited: from prohibition to conditional indications. Br J Ophthalmol. 2012;96(8):1078–83.
Seregard S, Tani E. Fine needle aspiration cytology in orbital tumors. Monogr Clin Cytol. 2012;21:82–9.
Ali MJ, Honavar SG, Vemuganti GK, et al. Fine needle aspiration biopsy of retinal tumors. Monogr Clin Cytol. 2012;21:72–81.
Turell ME, Hayden BC, McMahon JT, et al. Uveal schwannoma surgery. Ophthalmology. 2009;116(1):163–e6.
Caminal JM, Sanz S, Carreras M, et al. Epibulbar seeding at the site of a transvitreal fine-needle aspiration biopsy. Arch Ophthalmol. 2006;124(4):587–9.
Raja V, Russo A, Coupland S, et al. Extraocular seeding of choroidal melanoma after a transretinal biopsy with a 25-gauge vitrector. Retin Cases Brief Rep. 2011;5(3):194–6.
Schefler AC, Gologorsky D, Marr BP, et al. Extraocular extension of uveal melanoma after fine-needle aspiration, vitrectomy, and open biopsy. JAMA Ophthalmol. 2013;131(9):1220–4.
Finn AP, Materin MA, Mruthyunjaya P. CHOROIDAL TUMOR BIOPSY: a review of the current state and a glance into future techniques. Retina. 2018;38(Suppl 1):S79–87.
Biscotti CV, Singh AD. Uveal metastases. Monogr Clin Cytol. 2012;21:17–30.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Aziz, H.A., Pelayes, D., Biscotti, C.V., Singh, A.D. (2019). Diagnostic Techniques: FNAB. In: Singh, A., Damato, B. (eds) Clinical Ophthalmic Oncology. Springer, Cham. https://doi.org/10.1007/978-3-030-04489-3_23
Download citation
DOI: https://doi.org/10.1007/978-3-030-04489-3_23
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-04488-6
Online ISBN: 978-3-030-04489-3
eBook Packages: MedicineMedicine (R0)