Accuracy of clinical examination in the diagnosis of eyelid lesions

Abstract

Objective: To analyze the accuracy of the clinical examination in the diagnosis of eyelid lesions. Methods: From the observation of thirtyfive photos of benign and malignant eyelid tumors were presented to ophthalmologists, for each picture, it was asked 3 questions: 1) the lesion is malignant or not; 2) if considered malignant, the probably histological type; and 3) the tumor is aggressive or not. The phisicians were divided into 9 groups, according to academic degree (time since graduation and Oculoplastics specialty or not). Answers were compared with the results of the histopathologic study of the surgically resected tumor. Results: In total, one hundred and six ophthalmologists were interviewed. The professional experience influenced the diagnosis of malignancy of the tumor, as the Group 1 (first year residents) had the lowest accuracy (64.5%), with lower estimated agreement (kappa = 0.13), and Group 5 (graduated 5 years ago and with expertise in Oculoplastics) the highest accuracy (77.3%), with better agreement (Kappa = 0.45), and presented the best parameters for other analyzed items. For the histological type diagnosis, accuracy was lower: group 1 had the worst performance, with 51.1% accuracy, while the best was for group 6 (graduated over 5 years and with expertise in Oculoplastics, 77.2% ). As for the criterion of tumor aggressiveness, the results were closer among the different categories. Ophthalmologists trained longer and without expertise in Oculoplastics also showed a low diagnostic accuracy for malignancy and to determine the histological type of tumor. Conclusion: The low accuracy of clinical diagnosis of eyelid tumors in the groups above reinforces the need to improve ophthalmic oncology knowledge in these groups.Keywords: Eyelid neoplasms/diagnosis; Eyelid neoplasms/pathology; Medical oncology; Health knowledge, atitudes, practice RESUMOObjetivo: Analisar a acurácia do exame clínico no diagnóstico de lesões palpebrais. Métodos: A partir da observação de trinta e cinco fotos de tumores palpebrais benignos e malignos que foram apresentadas a médicos oftalmologistas, para cada foto foram feitas 3 perguntas: 1) lesão maligna ou não? 2) se considerado maligno, o provável tipo histológico; e 3) tumor agressivo ou não? Os médicos foram agrupados em 9 grupos, de acordo com a formação profissional (tempo de formação e especialização ou não em Oculoplástica). As respostas foram comparadas com o resultado do exame histopatológico da peça retirada cirurgicamente. Resultados: No total, cento e seis médicos oftalmologistas participaram do estudo. A experiência do profissional influenciou no diagnóstico de malignidade do tumor, já que o grupo 1 (residentes de primeiro ano) apresentou a menor acurácia (64,5%), com menor concordância estimada (Kappa = 0,13), e o grupo 5 (formados há 5 anos e especializados em Oculoplástica) a maior acurácia (77,3%), com melhor concordância (Kappa = 0,45), além de apresentar as melhores medidas para os demais itens avaliados. Para diagnóstico do tipo histológico, a ac...

Rare and Difficult Differential Diagnosis for Eyelid Tumor that Mimics Basal Cell Carcinoma-Case Report

“…Immunohistochemistry for BCC typically demonstrates positive expression of Ber-EP4 and AE1/AE3 while for TFI expression of Ber-EP4 is negative and for AE1/AE3 is positive. The accuracy of the clinical diagnosis of eyelid malignancies is variable in published studies ranging from 65% to 96% [1]. In our case, the presumed diagnosis of benign or malignant eyelid tumor based on clinical aspect was difficult.…”

“…Irregular borders, pearly lesions, ulceration, lesion that does not heal, telangiectasias are signs that suggest a malignancy but appearance can be variable and can lead to clinical confusion between benign and malignant lesions. Lesions in the periocular region are particular because of the eyelid skin characteristics, risk of malignant tumors to invade orbit, esthetic implications that can be dramatic in case of large and invading tumor, also that surgical treatment should preserve healthy peritumoral tissue in order to maintain a normal eyelid function and a healthy ocular surface for a good visual outcome [1].…”

“…TFI is a rare benign adnexal tumor that is often clinically not suspected but has characteristic histopathological features and unique staining aspect, like peripheral palisading and pale cells, also positive expression of AE1/AE3 and negative expression of Ber-EP4 [1,4]. TFI has a non-specific appearance and may be clinically misdiagnosed with other tumors, especially BCC which can lead to unnecessarily extensive surgery that may not be recommended for benign tumors especially in the periocular region where the need for preserving healthy peritumoral tissue is very important [9].…”

“…Periocular region can be the site for different types of benign and malignant tumors developing from epidermis, dermis or annexes. Although histological analysis is mandatory and gold standard for final diagnosis, clinical diagnosis is also important in order to ensure proper treatment, to establish the necessity of a wide or narrow peritumoral tissue excision depending the clinical tumor characteristics and to appreciate the prognosis [1].…”