The Role of Fine Needle Aspiration of Orbital Lesions: A Case Series

Abstract

Objective: This paper analyzes a series of ultrasound (US)-guided orbital fine needle aspirations (FNAs) which provide diagnostic information that cytopathologists approaching orbital lesions for the first time can find useful and underlines the importance of teamwork. Study Design: The investigators retrospectively obtained data from 24 consecutive orbital FNAs. For all patients, a complete clinicoradiological database was created. FNAs were performed under US guidance with 25-gauge needles and an aspiration biopsy syringe gun, and sent to the Department of Pathology for examination and data management. Results: The mean age of the patients was 54 years. Imaging studies included US, magnetic resonance imaging and computed tomography scans; 9 lesions involved the right orbit and 15 the left orbit. The mean lesion size was 23.6 ± 7.2 mm. After microscopic examination, 7 smears were labeled as ‘nondiagnostic', while in 17 cases a definitive diagnosis was proposed, which always proved to be correct (70.8%, specificity = 100%). Conclusions: The investigators believe that FNA biopsy of orbital masses is a necessary step; its weaknesses lie in the particularly delicate site of sampling and the extreme heterogeneity of lesions. Nevertheless, when orbital FNA is performed within a well-coordinated multidisciplinary team, it is a powerful tool that can be used to define the most appropriate management of these patients.

The role of ultrasound-guided tissue sampling techniques in the management of extra-ocular orbital lesions

“…8 We present the complications following ultrasoundguided orbital sampling described in the literature found in our review in Table 1. [12][13][14] Cutaneous eyelid haematoma was the most commonly encountered complication following ultrasound-guided sampling. This represents a minor complication that is not expected to cause permanent damage and the incidence cannot be reduced with image guidance.…”

“…6 Moreover, there is a purported increased risk of tumour seeding secondary to core biopsy procedures again due to the larger calibre of the needle. 6,14 For these reasons, FNA is often used as the initial sampling procedure and, for many tumours, cytology is adequate to produce a diagnosis. A number of non-ophthalmological studies have shown that increased diagnostic accuracy can be achieved with core biopsy over FNA without increasing the number of complications.…”

“…Orlandi et al 13 performed ultrasound-guided core biopsy on 13 orbital lesions using either linear 12-5 MHz or mini-convex 8-4 MHz probes. Pagni et al 14 performed ultrasound-guided FNA on 24 patients with orbital lesions.…”

Evaluation of cytology and histopathology for the diagnosis of canine orbital neoplasia: 112 cases (2004‐2019) and review of the literature

“…For cases for which both cytology and histopathology results were available, the rate of disagreement between the two modalities was surprisingly high but similar to that reported in the physician‐based literature. In people, fine needle aspirate for cytology of orbital lesions is nondiagnostic in 10%‐30% of cases and discordant with later histopathology in 10%‐31% of cases, while in our patient population 15% of cytology samples were nondiagnostic and 17% were overturned by later histopathology . No specific causative factors could be identified for cases in which cytology samples were considered nondiagnostic or were initially characterized as representative of an inflammatory rather than neoplastic process.…”

“…In people, fine needle aspirate for cytology of orbital lesions is nondiagnostic in 10%-30% of cases and discordant with later histopathology in 10%-31% of cases, while in our patient population 15% of cytology samples were nondiagnostic and 17% were overturned by later histopathology. [22][23][24][25][26] No specific causative factors could be identified for cases in which cytology samples were considered nondiagnostic or were initially characterized as representative of an inflammatory rather than neoplastic process. Of the 11 samples in these categories, 10 came from dogs who had undergone a CT and eight were obtained using ultrasound guidance, suggesting that failure to sample the lesion of interest was unlikely to be the reason for discordance.…”