Diagnosis and staging of ocular surface squamous neoplasia

Abstract

Background: Ocular surface squamous neoplasia (OSSN) is the most common ocular tumour. The diagnosis of OSSN is based on clinical suspicion and confirmed by various diagnostic modalities, of which histology is the gold standard. With the move to less invasive management options such as topical chemo- or immunotherapy, less invasive diagnostic options have come to the fore.Aim: The purpose of this article was to review the current staging and diagnostic modalities for OSSN with a focus on less invasive modalities.Method: A literature review was performed for publications on ocular surface neoplasia and diagnostic modalities.Results: Histology is the gold standard for diagnosing OSSN. Cytology has been shown to be a simple, repeatable and minimally invasive diagnostic modality, which also allows for additional testing such as polymerase chain reaction. Anterior segment optical coherence tomography provides a non-contact method of evaluating the ocular surface, with OSSN showing a thickened hyper-reflective epithelium, abrupt transition zone and demarcation line. Vital dyes are used less commonly with high sensitivity, but lower specificity for OSSN. Finally, confocal microscopy provides en-face images of the ocular surface, with OSSN showing a classic ‘starry night’ appearance.Conclusion: Histology remains the gold standard for diagnosis; however, with the increasing use of topical therapy for OSSN, there has been an increase in the uptake of less invasive diagnostic modalities.

Current Practice in the Treatment of Epithelial and Melanocytic Tumours with Interferon-α2b: A Survey of Tertiary Eye Centres in Germany

“…Still, the most compelling advantage of IFN- α 2b is a better safety profile in comparison to MMC or 5-FU, both of which often cause more pain and hyperaemia after instillation 7 , 8 , 20 . Furthermore, severe corneal side effects such as limbal stem cell deficiency, scleral melt, and punctal stenosis have been associated with MMC use; equally, 5-FU may cause lid swelling and punctate epithelial erosions 20 , 21 , 22 . Clinical efficacy of the three chemotherapeutic agents appears to be equal, but prospective clinical trials have not been performed so far 7 , 8 , 20 .…”

Comparison of non-invasive diagnostic modalities for ocular surface squamous neoplasia at a tertiary hospital, South Africa

“…OCT has become the favoured non-invasive diagnostic modality for OSSN. 3 Studies have reported sensitivities of 94-100% with speci cities of 100%. 5,6 Our study had lower sensitivity and speci city overall, but with a 100% sensitivity for SCC.…”

“…2 The gold standard for diagnosis is a biopsy with histology. 3 In recent years there has been a move from surgical management to the use of topical chemo or immunotherapies. 4 This has spurred the adoption of noninvasive modalities for diagnosis and the monitoring of response to therapy.…”

“…These diagnostic methods include optical coherence tomography (OCT), cytology, vital dye stains (methylene blue and toluidine blue) and confocal microscopy. 3 OCT has emerged as a useful tool to acquire an optical biopsy of a conjunctival lesion. [5][6][7][8] The classic features of OSSN on OCT are a (i) thickened hyperre ective epithelium, (ii) an abrupt transition from normal to abnormal epithelium, (iii) and a plane of separation between the epithelium and underlying stroma.…”

Peripheral ulcerative keratitis: A review of aetiology and management

“…105 Ocular surface squamous neoplasia Thickened disorganised conjunctival epithelium with mitotic figures superficial to the basal epithelium. 119 agents, such as CS, cyclosporin and tacrolimus, have been successfully used as an adjunct. 2,120 Topical steroids should be used with caution as they inhibit collagen synthesis and may increase the risk of perforation.…”