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1
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Gore C, Londhe M, Gurwale S, Nibe P. Pigmented Conjunctival Nevus: A Mystery Solved by Histopathology. Cureus 2024; 16:e64528. [PMID: 39139338 PMCID: PMC11321595 DOI: 10.7759/cureus.64528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2024] [Indexed: 08/15/2024] Open
Abstract
Inflammatory juvenile conjunctival nevi (IJCN) is a rare type of nevus and its clinical presentation overlaps with that of malignant conjunctival melanoma. It is a benign lesion that has been described to progress to melanoma in some cases. IJCN may clinically mimic melanoma due to its rapid growth features and atypical histology. Thus, its accurate diagnosis by histopathology is a prerequisite for proper management. Here, we present a case of conjunctival lesion mimicking melanoma clinically.
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Affiliation(s)
- Charusheela Gore
- Pathology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Mangesh Londhe
- Pathology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Sushama Gurwale
- Pathology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Pranjali Nibe
- Pathology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, IND
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Sinha S, Ramesh PV, Nishant P, Morya AK, Prasad R. Novel automated non-invasive detection of ocular surface squamous neoplasia using artificial intelligence. World J Methodol 2024; 14:92267. [PMID: 38983656 PMCID: PMC11229874 DOI: 10.5662/wjm.v14.i2.92267] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/19/2024] [Accepted: 04/12/2024] [Indexed: 06/13/2024] Open
Abstract
Ocular surface squamous neoplasia (OSSN) is a common eye surface tumour, characterized by the growth of abnormal cells on the ocular surface. OSSN includes invasive squamous cell carcinoma (SCC), in which tumour cells penetrate the basement membrane and infiltrate the stroma, as well as non-invasive conjunctival intraepithelial neoplasia, dysplasia, and SCC in-situ thereby presenting a challenge in early detection and diagnosis. Early identification and precise demarcation of the OSSN border leads to straightforward and curative treatments, such as topical medicines, whereas advanced invasive lesions may need orbital exenteration, which carries a risk of death. Artificial intelligence (AI) has emerged as a promising tool in the field of eye care and holds potential for its application in OSSN management. AI algorithms trained on large datasets can analyze ocular surface images to identify suspicious lesions associated with OSSN, aiding ophthalmologists in early detection and diagnosis. AI can also track and monitor lesion progression over time, providing objective measurements to guide treatment decisions. Furthermore, AI can assist in treatment planning by offering personalized recommendations based on patient data and predicting the treatment response. This manuscript highlights the role of AI in OSSN, specifically focusing on its contributions in early detection and diagnosis, assessment of lesion progression, treatment planning, telemedicine and remote monitoring, and research and data analysis.
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Affiliation(s)
- Sony Sinha
- Department of Ophthalmology–Vitreo Retina, Neuro Ophthalmology and Oculoplasty, All India Institute of Medical Sciences, Patna 801507, India
| | | | - Prateek Nishant
- Department of Ophthalmology, ESIC Medical College, Patna 801113, India
| | - Arvind Kumar Morya
- Department of Ophthalmology, All India Institute of Medical Sciences, Hyderabad 508126, India
| | - Ripunjay Prasad
- Department of Ophthalmology, RP Eye Institute, Delhi 110001, India
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García-Onrubia L, Pacheco-Callirgos GE, García-Álvarez C, Muñoz-Moreno MF, García-Lagarto E, Almaraz-Gómez A, Saornil-Álvarez MA. Clinic-pathological agreement in the diagnosis of conjunctival tumours: Analysis of 195 cases. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023:S2173-5794(23)00107-X. [PMID: 37369322 DOI: 10.1016/j.oftale.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/07/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE The present study aims to assess the agreement between clinical and pathological diagnosis in conjunctival tumours in a specialist ocular oncology unit. METHODS retrospective study of consecutive patients with conjunctival tumours diagnosed at the Ocular Oncology Unit of the University Hospital of Valladolid was performed from 1992 to 2017. Tumours were classified according to their origin (epithelial, melanocytic, lymphoid and others) and degree of malignancy (benign, premalignant, malignant). A biopsy was performed in cases of symptomatic or growing lesions. Cohen´s kappa (κ) statistics was used as an indicator of agreement between clinical and pathological diagnosis. RESULTS Of 462 consecutive patients, a biopsy was required in 195 (42.2%). The agreement with the pathological diagnosis was successful in 154 (79.0%) cases. Analysis according to the grade of malignancy showed the lowest rate of agreement among benign (n = 83; 91.6%) and premalignant (n = 62; 90.3%) lesions, with a total agreement in malignant lesions (n = 50; 100%); the Cohen´s kappa coefficient (κ) was 0.90. The highest rates of concordance were found in epithelial, melanocytic and soft tissue lesions with κ values of 1, 0.8 and 1 respectively. The worst rate of concordance was found in lymphoid lesions with a κ value of 0.3. CONCLUSION Most of the conjunctival tumours were correctly identified clinically; benign and malignant lesions showed the highest rate of accuracy; however, premalignant tumours can hide micro-invasive diseases that can go unnoticed on clinical examination. The biopsy is essential for accurate diagnosis and treatment.
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Affiliation(s)
- L García-Onrubia
- Unidad de Tumores Oculares, Departamento de Oftalmología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Moorfields Eye Hospital NHS Foundation Trust, Londres, United Kingdom.
| | - G E Pacheco-Callirgos
- Unidad de Tumores Oculares, Departamento de Oftalmología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - C García-Álvarez
- Unidad de Tumores Oculares, Departamento de Oftalmología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - M F Muñoz-Moreno
- Unidad de Tumores Oculares, Unidad de Investigación, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - E García-Lagarto
- Departamento de Patología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - A Almaraz-Gómez
- Departamento de Epidemiología y Medicina Preventiva, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - M A Saornil-Álvarez
- Unidad de Tumores Oculares, Departamento de Oftalmología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Habibalahi A, Allende A, Michael J, Anwer AG, Campbell J, Mahbub SB, Bala C, Coroneo MT, Goldys EM. Pterygium and Ocular Surface Squamous Neoplasia: Optical Biopsy Using a Novel Autofluorescence Multispectral Imaging Technique. Cancers (Basel) 2022; 14:1591. [PMID: 35326744 PMCID: PMC8946656 DOI: 10.3390/cancers14061591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 02/04/2023] Open
Abstract
In this study, differentiation of pterygium vs. ocular surface squamous neoplasia based on multispectral autofluorescence imaging technique was investigated. Fifty (N = 50) patients with histopathological diagnosis of pterygium (PTG) and/or ocular surface squamous neoplasia (OSSN) were recruited. Fixed unstained biopsy specimens were imaged by multispectral microscopy. Tissue autofluorescence images were obtained with a custom-built fluorescent microscope with 59 spectral channels, each with specific excitation and emission wavelength ranges, suitable for the most abundant tissue fluorophores such as elastin, flavins, porphyrin, and lipofuscin. Images were analyzed using a new classification framework called fused-classification, designed to minimize interpatient variability, as an established support vector machine learning method. Normal, PTG, and OSSN regions were automatically detected and delineated, with accuracy evaluated against expert assessment by a specialist in OSSN pathology. Signals from spectral channels yielding signals from elastin, flavins, porphyrin, and lipofuscin were significantly different between regions classified as normal, PTG, and OSSN (p < 0.01). Differential diagnosis of PTG/OSSN and normal tissue had accuracy, sensitivity, and specificity of 88 ± 6%, 84 ± 10% and 91 ± 6%, respectively. Our automated diagnostic method generated maps of the reasonably well circumscribed normal/PTG and OSSN interface. PTG and OSSN margins identified by our automated analysis were in close agreement with the margins found in the H&E sections. Such a map can be rapidly generated on a real time basis and potentially used for intraoperative assessment.
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Affiliation(s)
- Abbas Habibalahi
- ARC Centre of Excellence for Nanoscale Biophotonics, University of New South Wales, Sydney, NSW 2032, Australia; (J.M.); (A.G.A.); (J.C.); (S.B.M.); (E.M.G.)
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, NSW 2032, Australia
| | - Alexandra Allende
- Douglass Hanly Moir Pathology, Macquarie Park, NSW 2113, Australia;
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Jesse Michael
- ARC Centre of Excellence for Nanoscale Biophotonics, University of New South Wales, Sydney, NSW 2032, Australia; (J.M.); (A.G.A.); (J.C.); (S.B.M.); (E.M.G.)
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, NSW 2032, Australia
| | - Ayad G. Anwer
- ARC Centre of Excellence for Nanoscale Biophotonics, University of New South Wales, Sydney, NSW 2032, Australia; (J.M.); (A.G.A.); (J.C.); (S.B.M.); (E.M.G.)
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, NSW 2032, Australia
| | - Jared Campbell
- ARC Centre of Excellence for Nanoscale Biophotonics, University of New South Wales, Sydney, NSW 2032, Australia; (J.M.); (A.G.A.); (J.C.); (S.B.M.); (E.M.G.)
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, NSW 2032, Australia
| | - Saabah B. Mahbub
- ARC Centre of Excellence for Nanoscale Biophotonics, University of New South Wales, Sydney, NSW 2032, Australia; (J.M.); (A.G.A.); (J.C.); (S.B.M.); (E.M.G.)
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, NSW 2032, Australia
| | - Chandra Bala
- Department of Ophthalmology, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW 2109, Australia;
| | - Minas T. Coroneo
- Department of Ophthalmology, University of New South Wales at Prince of Wales Hospital, High Street, Randwick, NSW 2031, Australia;
| | - Ewa M. Goldys
- ARC Centre of Excellence for Nanoscale Biophotonics, University of New South Wales, Sydney, NSW 2032, Australia; (J.M.); (A.G.A.); (J.C.); (S.B.M.); (E.M.G.)
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, NSW 2032, Australia
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Abstract
Purpose of review To review and update the latest findings in diagnosis and management of ocular surface squamous neoplasia (OSSN). Recent findings OSSN is the most common anterior segment neoplastic disease process. Several ocular surface imaging techniques have been developed for the early diagnosis and management of clinical and subclinical ocular surface squamous neoplasia, including high-resolution optical coherence tomography (HR-OCT), in vivo confocal microscopy, and ultrasound biomicroscopy. Treatment modalities include both surgical and medical management, with a recent trend towards primary and adjunctive pharmacotherapy. Summary There is increasing use of HR-OCT for the diagnosis and monitoring of clinical and subclinical OSSN lesions. Topical pharmacotherapy agents, including interferon α-2b, 5-fluorouracil, and mitomycin C, have demonstrable efficacy in the treatment of OSSN and their use may be dictated based upon tumor factors, patient factors, cost, and side effect profile. Both surgical excision and adjunctive topical medications have excellent success, with the favored treatment method trending towards topical pharmacotherapy as primary therapy.
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Almeida SRAD, Martins MC, Barros JDN, Lowen MS, Alves M, Burnier MN. Ocular surface findings in impression cytology after interferon a2b or mitomycin C in rabbits. REVISTA BRASILEIRA DE OFTALMOLOGIA 2021. [DOI: 10.37039/1982.8551.20210018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ocran C, Harmsen H, Shieh C. A Man With a Cloudy Cornea. JAMA Ophthalmol 2021; 139:238-239. [PMID: 33355628 DOI: 10.1001/jamaophthalmol.2020.4646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Cindy Ocran
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Nashville, Tennessee
| | - Hannah Harmsen
- Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christine Shieh
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Nashville, Tennessee
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Höllhumer R, Michelow P, Williams S. Diagnosis and staging of ocular surface squamous neoplasia. AFRICAN VISION AND EYE HEALTH 2020. [DOI: 10.4102/aveh.v79i1.590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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.
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Moshtaghion SM, Abolhosseini M, Rezaei Kanavi M, Hosseini SB, Rezaei Kanavi M. Impression cytology for detection of clinically suspected ocular surface disorders: A cross-sectional study. Eur J Ophthalmol 2020; 31:943-950. [PMID: 32506955 DOI: 10.1177/1120672120932093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Investigating impression cytology (IC) results of various types of clinically suspected ocular surface lesions over a 14-year period in a referral center in Iran. METHODS IC findings obtained from patients with different types of ocular surface disorders between 2005 and 2018 were reviewed. Agreement between clinical suspicions and IC results was evaluated by calculating Cohen's Kappa coefficient (CKC). RESULTS Clinical suspicions in 688 surveyed eyes were ocular surface squamous neoplasia (OSSN, 42.0%), limbal stem cell deficiency (LSCD, 36.3%), dry eye-related disorders (DERD, 11.5%), Acanthamoeba keratitis (AK, 7.2%), benign pigmented lesions (BPL, 1.9%), immune-related conjunctivitis (IRC, 0.7%), and malignant pigmented lesions (MPL, 0.4%). General agreement between clinical suspicions and IC results was 0.68 for all groups. This agreement was almost perfect in AK (CKC = 0.966) and BPLs (CKC = 0.843), and was substantial in MPLs (CKC = 0.749), OSSNs (CKC = 0.684), and LSCD (CKC = 0.612). CKC in IRC (0.567) and DERDs (0.443) was moderate. Histopathologic results were available in 22 eyes and were well-correlated with corresponding IC results (CKC = 0.86). Multiple post-treatment follow-up sessions of IC were performed in 51 eyes (11.4%) that had diagnosis of LSCD (31), OSSN (17), and MPL (3) at the first IC session. CONCLUSION Our survey not only demonstrated an overall substantial agreement between IC results and primary clinical suspicions, but also showed an almost perfect correlation between IC results and existent histopathologic data. Therefore, IC as a non-invasive diagnostic modality can be of great importance in proper diagnosis of various ocular surface diseases especially when distinguishing malignant from benign lesions is required.
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Affiliation(s)
| | | | - Mozhgan Rezaei Kanavi
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Bagher Hosseini
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Central Eye Bank of Iran, Tehran, Iran
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Aliakbar Navahi R, Hosseini SB, Kanavi MR, Rakhshani N, Aghaei H, Kheiri B. Comparison of toluidine blue 1% staining patterns in cytopathologically confirmed ocular surface squamous neoplasias and in non-neoplastic lesions. Ocul Surf 2019; 17:578-583. [DOI: 10.1016/j.jtos.2019.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 02/24/2019] [Accepted: 04/30/2019] [Indexed: 11/15/2022]
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Habibalahi A, Bala C, Allende A, Anwer AG, Goldys EM. Novel automated non invasive detection of ocular surface squamous neoplasia using multispectral autofluorescence imaging. Ocul Surf 2019; 17:540-550. [PMID: 30904597 DOI: 10.1016/j.jtos.2019.03.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/28/2019] [Accepted: 03/12/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Diagnosing Ocular surface squamous neoplasia (OSSN) using newly designed multispectral imaging technique. METHODS Eighteen patients with histopathological diagnosis of Ocular Surface Squamous Neoplasia (OSSN) were recruited. Their previously collected biopsy specimens of OSSN were reprocessed without staining to obtain auto fluorescence multispectral microscopy images. This technique involved a custom-built spectral imaging system with 38 spectral channels. Inter and intra-patient frameworks were deployed to automatically detect and delineate OSSN using machine learning methods. Different machine learning methods were evaluated, with K nearest neighbor and Support Vector Machine chosen as preferred classifiers for intra- and inter-patient frameworks, respectively. The performance of the technique was evaluated against a pathological assessment. RESULTS Quantitative analysis of the spectral images provided a strong multispectral signature of a relative difference between neoplastic and normal tissue both within each patient (at p < 0.0005) and between patients (at p < 0.001). Our fully automated diagnostic method based on machine learning produces maps of the relatively well circumscribed neoplastic-non neoplastic interface. Such maps can be rapidly generated in quasi-real time and used for intraoperative assessment. Generally, OSSN could be detected using multispectral analysis in all patients investigated here. The cancer margins detected by multispectral analysis were in close and reasonable agreement with the margins observed in the H&E sections in intra- and inter-patient classification, respectively. CONCLUSIONS This study shows the feasibility of using multispectral auto-fluorescence imaging to detect and find the boundary of human OSSN. Fully automated analysis of multispectral images based on machine learning methods provides a promising diagnostic tool for OSSN which can be translated to future clinical applications.
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Affiliation(s)
- Abbas Habibalahi
- ARC Centre of Excellence for Nanoscale Biophotonics, Macquarie University, North Ryde, NSW, 2109, Australia; School of Engineering, Faculty of Science and Engineering, Macquarie University, Sydney, NSW, 2109, Australia; Graduate School of Biomedical Engineering, University of New South Wales, Sydney, 2032, NSW, Australia.
| | - Chandra Bala
- Department of Ophthalmology, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, 2109, Australia
| | - Alexandra Allende
- Douglass Hanly Moir Pathology, Macquarie Park, Sydney, NSW, 2113, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, 2109, Australia
| | - Ayad G Anwer
- ARC Centre of Excellence for Nanoscale Biophotonics, Macquarie University, North Ryde, NSW, 2109, Australia; Graduate School of Biomedical Engineering, University of New South Wales, Sydney, 2032, NSW, Australia
| | - Ewa M Goldys
- ARC Centre of Excellence for Nanoscale Biophotonics, Macquarie University, North Ryde, NSW, 2109, Australia; Graduate School of Biomedical Engineering, University of New South Wales, Sydney, 2032, NSW, Australia.
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Kanavi MR, Hosseini SB, Aliakbar-Navahi R, Aghaei H. Impression Cytology in a Series of Clinically Diagnosed Ocular Surface Melanocytic Lesions. J Ophthalmic Vis Res 2017; 12:17-22. [PMID: 28299002 PMCID: PMC5340058 DOI: 10.4103/jovr.jovr_72_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To report impression cytology (IC) results of clinically diagnosed ocular surface melanocytic lesions. METHODS Ten patients with a clinical diagnosis of an ocular surface melanocytic lesion underwent IC using cellulose acetate strips and Periodic acid Schiff-Papanicolaou staining. Excisional biopsy of lesions was performed in case of observing atypical cells on IC or at the patient's request, and excised specimens were subjected to histopathological analysis. Agreement between clinical diagnoses and IC results and between IC results and histopathology were evaluated. RESULTS Clinical diagnoses were nevi in 6, primary acquired melanosis (PAM) with atypia/melanoma in 2, and atypical nevus versus pigmented conjunctival intraepithelial neoplasia (CIN) in 2 cases. IC results were suggestive of a benign nevus in 7, PAM with atypia/melanoma in 2 and CIN versus an atypical epithelioid type melanocytic lesion in 1 case. IC results were consistent with the clinical diagnoses in 9 cases (Cohen's kappa index of 0.83) and excluded CIN in 1. Histopathology in 6 cases disclosed benign melanonevus in 3, malignant melanoma in the context of PAM with atypia in 2, and CIN in 1 case. Histologic results were well correlated with the IC features (Cohen's kappa index of 0.74). CONCLUSION By demonstrating typical cytomorphological features of ocular superficial layers IC diagnosed the true nature of melanocytic ocular surface lesions in the majority of cases. Although IC does not substitute histopathology, given the high correlation between IC results and histopathology, it can be of great assistance in diagnosis and management of ocular surface melanocytic lesions.
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Affiliation(s)
- Mozhgan Rezaei Kanavi
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Bagher Hosseini
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Central Eye Bank of Iran, Tehran, Iran
| | | | - Hossein Aghaei
- Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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13
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Anterior Segment Imaging in Ocular Surface Squamous Neoplasia. J Ophthalmol 2016; 2016:5435092. [PMID: 27800176 PMCID: PMC5069377 DOI: 10.1155/2016/5435092] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 08/15/2016] [Indexed: 12/21/2022] Open
Abstract
Recent advances in anterior segment imaging have transformed the way ocular surface squamous neoplasia (OSSN) is diagnosed and monitored. Ultrasound biomicroscopy (UBM) has been reported to be useful primarily in the assessment of intraocular invasion and metastasis. In vivo confocal microscopy (IVCM) shows enlarged and irregular nuclei with hyperreflective cells in OSSN lesions and this has been found to correlate with histopathology findings. Anterior segment optical coherence tomography (AS-OCT) demonstrates thickened hyperreflective epithelium with an abrupt transition between abnormal and normal epithelium in OSSN lesions and this has also been shown to mimic histopathology findings. Although there are limitations to each of these imaging modalities, they can be useful adjunctive tools in the diagnosis of OSSN and could greatly assist the clinician in the management of OSSN patients. Nevertheless, anterior segment imaging has not replaced histopathology's role as the gold standard in confirming diagnosis.
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14
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da Cunha LP, Barros JN, Motono M, Costa FD, da Cunha MC, Chojniak MM. Conjunctival follicular lymphoma after treatment for invasive squamous cell carcinoma. Case Rep Ophthalmol 2015; 5:444-50. [PMID: 25606037 PMCID: PMC4296246 DOI: 10.1159/000369963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Backgrounds/Aims The authors describe the case of a 79-year-old Caucasian woman who presented an ocular adnexal lesion as the first clinical manifestation of a systemic follicular lymphoma, highlighting the clinicopathological features of this rare entity and its potential to be misdiagnosed as marginal zone lymphoma of the mucosa-associated lymphoid tissue. Methods Conjunctival impression cytology was performed for a rapid initial diagnosis of lymphoma, and subsequent histopathological and immunohistochemical studies were carried out for its confirmation and to identify the best therapeutic regimen. Results After the initial presentation and diagnosis, she was submitted to complete clinical evaluation; confluent retroperitoneal lymphadenopathy was detected through abdominal computed tomography, characterizing clinical stage III. Conclusion Awareness of this lymphoma is important when making a diagnosis of ocular adnexal lymphoid neoplasms for its appropriate evaluation and management.
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Affiliation(s)
| | | | - Marcia Motono
- Clínica de Olhos Dr. Moacir Cunha, Brazil ; A.C. Camargo Cancer Center, São Paulo, Brazil
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15
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Wong JR, Nanji AA, Galor A, Karp CL. Management of conjunctival malignant melanoma: a review and update. EXPERT REVIEW OF OPHTHALMOLOGY 2014; 9:185-204. [PMID: 25580155 DOI: 10.1586/17469899.2014.921119] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Conjunctival malignant melanoma is a pigmented lesion of the ocular surface. It is an uncommon but potentially devastating tumor that may invade the local tissues of the eye, spread systemically through lymphatic drainage and hematogenous spread, and recur in spite of treatment. Despite its severity, the rarity of available cases has limited the evidence for diagnosis and management. This review will provide an overview of the epidemiology, presentation, diagnosis, management, and surveillance of conjunctival melanoma, with an emphasis on recent advances in biological therapies to treat this disease.
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Affiliation(s)
- James R Wong
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Afshan A Nanji
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA ; Department of Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA
| | - Carol L Karp
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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16
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Steffen J, Rice J, Lecuona K, Carrara H. Identification of ocular surface squamous neoplasia by in vivo staining with methylene blue. Br J Ophthalmol 2013; 98:13-5. [PMID: 24158840 DOI: 10.1136/bjophthalmol-2013-303956] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AIM To evaluate the diagnostic accuracy of methylene blue used as a non-invasive in vivo stain to detect ocular surface squamous neoplasia (OSSN). METHODS A test validation study was performed according to Standards for the reporting of diagnostic accuracy studies (STARD) guidelines on 75 consecutive patients who presented with ocular surface lesions suspicious of OSSN. Methylene blue 1% was instilled in vivo following local anaesthetic. Stain results were documented photographically and read by an independent observer. Lesions were excised at the same visit and evaluated histologically by pathologists who were blind to the stain results. Sensitivity, specificity, positive and negative predictive values were determined. RESULTS Thirty-three patients had histologically malignant lesions, of which 32 stained with methylene blue, and 42 patients had benign or premalignant lesions, of which 21 stained with methylene blue. Methylene blue had a sensitivity of 97%, specificity of 50% and positive and negative predictive values of 60% and 96%, respectively. CONCLUSIONS The topical application of methylene blue is a simple, inexpensive, non-invasive diagnostic test that can be helpful in excluding malignant ocular surface lesions but cannot replace histology as gold standard for diagnosis of OSSN.
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Affiliation(s)
- Jonel Steffen
- Division of Ophthalmology, University of Cape Town, , Cape Town, Western Cape, South Africa
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Anterior Segment OCT and Confocal Microscopy Findings in Atypical Corneal Intraepithelial Neoplasia. Cornea 2013; 32:875-9. [DOI: 10.1097/ico.0b013e318285cab9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Diagnosis of ocular surface lesions using ultra-high-resolution optical coherence tomography. Ophthalmology 2013; 120:883-91. [PMID: 23347984 DOI: 10.1016/j.ophtha.2012.10.025] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 10/15/2012] [Accepted: 10/18/2012] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To assess the use of ultra-high-resolution (UHR) optical coherence tomography (OCT) in the diagnosis of ocular surface lesions. DESIGN Prospective, noncomparative, interventional case series. PARTICIPANTS Fifty-four eyes of 53 consecutive patients with biopsy-proven ocular surface lesions: 8 primary acquired melanosis lesions, 5 amelanotic melanoma lesions, 2 nevi, 19 ocular surface squamous neoplasia lesions, 1 histiocytosis lesion, 6 conjunctival lymphoma lesions, 2 conjunctival amyloidosis lesions, and 11 pterygia lesions. INTERVENTION Ultra-high-resolution OCT imaging of the ocular surface lesions. MAIN OUTCOME MEASURES Clinical course and photographs, UHR OCT image, and histopathologic findings. RESULTS Ultra-high-resolution OCT images of all examined ocular surface lesions showed close correlation with the obtained histopathologic specimens. When clinical differential diagnosis of ocular surface lesions was broad, UHR OCT images provided optical signs indicating a more specific diagnosis and management. In cases of amelanotic melanoma, conjunctival amyloidosis, and primary histiocytosis and in 1 case of ocular surface squamous neoplasia, UHR OCT was instrumental in guiding the diagnosis. In those cases, UHR OCT suggested that the presumed clinical diagnosis was incorrect and favored a diagnosis that later was confirmed by histopathologic examination. CONCLUSIONS Correlations between UHR OCT and histopathologic findings confirm that UHR OCT is an adjunctive diagnostic method that can provide a noninvasive means to help guide diagnosis and management of ocular surface lesions. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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[Conjunctival keratoacanthoma: diagnosis, treatment and monitoring by conjunctival impression cytology]. ACTA ACUST UNITED AC 2012; 87:82-5. [PMID: 22423657 DOI: 10.1016/j.oftal.2011.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 06/02/2011] [Accepted: 08/09/2011] [Indexed: 11/21/2022]
Abstract
CASE REPORT We present a case report of a 28-year-old patient with a lesion that is compatible both clinically and histopathologically with conjunctival keratoacanthoma. The treatment given was complete excision and 0.04% mitomycin C eye drops in the postoperative period. The outcome was a complete clinical remission during the follow-up period (6 months). DISCUSSION It is important to make a correct differential diagnosis between keratoacanthoma and squamous cell carcinoma, as well as carrying out close monitoring after surgery due to the possibility of relapse and conversion to squamous cell carcinoma. For this reason, we propose the use of conjunctival impression cytology as a non-invasive method for monitoring such patients.
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Diagnosis and Management of Conjunctival and Corneal Intraepithelial Neoplasia Using Ultra High-Resolution Optical Coherence Tomography. Ophthalmology 2011; 118:1531-7. [DOI: 10.1016/j.ophtha.2011.01.005] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2010] [Revised: 12/19/2010] [Accepted: 01/04/2011] [Indexed: 11/18/2022] Open
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Abstract
PURPOSE To analyse in vivo structural and cellular features of ocular surface squamous neoplasia using clinical confocal microscopy. METHODS Ten consecutive cases of untreated ocular surface squamous neoplasia were in vivo investigated using clinical confocal microscopy (ConfoScan4, Nidek Co. Ltd, Gamagori, Japan) with a × 40 surface non-contact objective lens. Confocal microscopy images were compared with cytologic samples obtained by scraping technique. RESULTS Confocal microscopy examination revealed large areas of superficial cells debris and/or keratin debris accompanied by syncytial-like groupings, loss of the normal structure of the conjunctival epithelium and or of the corneal basal epithelium layer, papillomatous organization, large fibrovascular structures, and fine vessels perpendicular to the tumour surface. Sub-epithelial (pre-Bowman) space involvement was documented in four cases (50%). Irregular healthy tissue infiltration at the lateral edge of the lesion was documented in two cases (20%) whereas abrupt demarcation between neoplastic cells and normal epithelium was documented in eight cases (80%). In vivo cyto-morphologic study using clinical confocal microscopy showed cellular anisocytosis, pleocytosis, and anisonucleosis, enlarged nuclei with high nuclear to cytoplasmic ratio, high reflective cytoplasm and indistinct cytoplasmic borders in all cases (100%) . CONCLUSION CCM appears to be a promising and non-invasive method for in vivo structural and cellular analysis of OSSN.
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Impression cytologic analysis after corneal collagen cross-linking using riboflavin and ultraviolet-A light in the treatment of keratoconus. Cornea 2010; 29:1139-44. [PMID: 20622670 DOI: 10.1097/ico.0b013e3181d4f91a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report impression cytologic (IC) results after corneal cross-linking (CXL) using riboflavin and ultraviolet-A light in the treatment of keratoconus and compare the data with those from a group of subjects with the same disease. METHODS Forty eyes were distributed into 2 groups: patients in group 1 underwent CXL, whereas patients in group 2 received riboflavin 0.1% eyedrops for 1 month of topical use. IC specimens were obtained from all eyes before treatment and 1 and 3 months after treatment. RESULTS Patients in group 1 showed a decrease in goblet cell density on the superior conjunctiva after CXL (P = 0.008) but no difference on the temporal conjunctiva or in the cornea. Patients in group 2 demonstrated improvement in cell-to-cell contact of epithelial cells and reduced keratinization on the temporal conjunctiva after treatment (P = 0.003 and P = 0.034, respectively) but no changes on the superior conjunctiva or in the cornea. Fisher exact test comparison of IC total scores after treatment revealed no difference between groups. CONCLUSIONS Despite changes in goblet cell density after corneal CXL in the superior conjunctiva and an improvement in the morphology of epithelial cells after the use of riboflavin eyedrops, comparison of total IC scores showed no difference between groups.
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