Uveal Melanoma: Prognostication

Turell, Mary E.; Tubbs, Raymond R.; Biscotti, Charles V.; Singh, Arun D.

doi:10.1159/000331035

Cited by 11 publications

(6 citation statements)

References 32 publications

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“…9 Many patients with uveal melanoma are offered the option of prognostic testing, 9 wherein primary tumor cells are genotyped to determine whether the patient has low risk (0%-5%) or high risk (60%-100%) of metastases. [10][11][12] That the loss of a chromosome 3 is associated with the development of metastasis is well established, and a variety of techniques are being used clinically to test tumors for detection of monosomy 3 and gene expression profiling. [10][11][12] The purpose of this testing is somewhat different from that of most other prognostic tests in patients with newly diagnosed cancer.…”

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confidence: 99%

“…[10][11][12] That the loss of a chromosome 3 is associated with the development of metastasis is well established, and a variety of techniques are being used clinically to test tumors for detection of monosomy 3 and gene expression profiling. [10][11][12] The purpose of this testing is somewhat different from that of most other prognostic tests in patients with newly diagnosed cancer. Typically, prognostic tests are used to guide adjuvant therapy recommendations.…”

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“…13,14 In the absence of easy access to an adjuvant treatment trial, 15 the prognostic information is either used to increase the frequency of systemic surveillance to detect preclinical metastatic disease or to help the patients in end-of-life planning. 10 Decision regret is the sensation of disappointment or distress about a decision that one has made. Although everyone has regrets from time to time, it can occur more often when a person has major depression or an anxiety disorder.…”

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Depression, Anxiety, and Regret Before and After Testing to Estimate Uveal Melanoma Prognosis

et al. 2016

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IMPORTANCE To our knowledge, longitudinal assessment of depression, anxiety, and decision regret (a sense of disappointment or dissatisfaction in the decision) in patients undergoing prognostication for uveal melanoma does not exist. OBJECTIVE To report on depression, anxiety, and decision regret before and after testing to estimate uveal melanoma prognosis. DESIGN, SETTING, AND PARTICIPANTS Prospective interventional case series conducted at an institutional referral practice of 96 patients with clinical diagnosis of uveal melanoma who underwent prognostication at the time of primary therapy.MAIN OUTCOMES AND MEASURES Depression, anxiety, and decision regret prior to prognostication (baseline) and at 3 and 12 months afterwards. The Hospital Anxiety and Depression Scale (HADS) and Decision Regret Scale were self-administered by the patients prior to prognostication (baseline) and at 3 and 12 months afterwards. Data were summarized using means and standard deviations for continuous measures, frequencies, and percentages for categorical factors. A mixed model was used to assess the trajectory of HADS anxiety and the associations between HADS anxiety and baseline HADS depression, baseline decision regret, prognostication test result, and adjuvant therapy, respectively, while adjusting for age and sex. RESULTS Ninety-six patients (median age 60.7 years) completed baseline questionnaires. The mean (SD) HADS anxiety score at baseline (7.4 [4.0]) was higher than at 3 months (5.4 [3.7]; P < .001) or 12 months (4.7 [3.4]; P < .001), and decreased with older age (coefficient estimate [SD], −0.06 [0.02]; P < .001). The decision regret score was associated with baseline HADS depression score (coefficient estimate [SE], −1.17 [0.43]; P < .007), and HADS depression score increased with baseline HADS anxiety score (coefficient estimate [SE], 0.39 [0.06]; P < .001). CONCLUSIONS AND RELEVANCEOur study raises questions about decision regret in patients who agree to have a prognostic test that may not help guide treatment. Although decision regret appears to lessen or dissipate with time, study on larger numbers of patients is necessary to elucidate factors that may be addressed to mitigate decision regret.

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Depression, Anxiety, and Regret Before and After Testing to Estimate Uveal Melanoma Prognosis

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“…Some patients demand histopathological confirmation before an enucleation is performed. In uveal melanoma, genetical examinations are getting more important, as they can provide important prognostic information such as metastatic potential of the neoplasia [3]. FNAB, the frequently used method for intraocular biopsy, obtains little specimen and can therefore only be processed for cytological and immunocytological examinations.…”

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confidence: 99%

Biopsy with the New Essen Biopsy Forceps

Traine

Schedler

Brusa

et al. 2013

Case Reports in Ophthalmological Medicine

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Purpose. To present initial experience with a novel biopsy method, the Essen biopsy forceps. Therefore, two patients with diagnostic suspicion of uveal melanoma underwent biopsy for histopathological confirmation. Case Presentation. Two patients presented with painless unilateral vision reduction. Ultrasound revealed the diagnostic suspicion of uveal melanoma. Therefore, biopsy with the Essen biopsy forceps using a sutureless 23-gauge three-port vitrectomy system was performed. The specimens were then submitted to a pathologist and processed. Histopathology of the obtained specimen confirmed the diagnostic suspicion of choroid melanoma in both patients. Conclusion. Essen biopsy forceps is a very practicable alternative method to the FNAB, allowing a combined histopathological and immunohistochemical examination for achieving high diagnostic accuracy at minimal risk.

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“…All patients underwent cytogenetic analysis of a tumor sample obtained by fine-needle aspiration biopsy using a 25-gauge needle at the time of plaque placement [17,18]. Anteriorly located tumors had an open flap transscleral biopsy, while posteriorly located tumors underwent a transvitreal biopsy under indirect ophthalmoscopy visualization.…”

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Uveal Melanoma Regression after Brachytherapy: Relationship with Chromosome 3 Monosomy Status

et al. 2016

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Aim: The objective was to evaluate the relationship between the regression rate of ciliary body melanoma and choroidal melanoma after brachytherapy and chromosome 3 monosomy status. Methods: We conducted a prospective and consecutive case series of patients who underwent biopsy and brachytherapy for ciliary/choroidal melanoma. Tumor biopsy performed at the time of radiation plaque placement was analyzed with fluorescence in situ hybridization to determine the percentage of tumor cells with chromosome 3 monosomy. The regression rate was calculated as the percent change in tumor height at months 3, 6, and 12. The relationship between regression rate and tumor location, initial tumor height, and chromosome 3 monosomy (percentage) was assessed by univariate linear regression (R version 3.1.0). Results: Of the 75 patients included in the study, 8 had ciliary body melanoma, and 67 were choroidal melanomas. The mean tumor height at the time of diagnosis was 5.2 mm (range: 1.90-13.00). The percentage composition of chromosome 3 monosomy ranged from 0-20% (n = 35) to 81-100% (n = 40). The regression of tumor height at months 3, 6, and 12 did not statistically correlate with tumor location (ciliary or choroidal), initial tumor height, or chromosome 3 monosomy (percentage). Conclusion: The regression rate of choroidal melanoma following brachytherapy did not correlate with chromosome 3 monosomy status.

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Uveal Melanoma: Prognostication

Cited by 11 publications

References 32 publications

Depression, Anxiety, and Regret Before and After Testing to Estimate Uveal Melanoma Prognosis

Depression, Anxiety, and Regret Before and After Testing to Estimate Uveal Melanoma Prognosis

Biopsy with the New Essen Biopsy Forceps

Uveal Melanoma Regression after Brachytherapy: Relationship with Chromosome 3 Monosomy Status

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