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Prognostic biopsy of choroidal melanoma: an optimised surgical and laboratory approach
  1. Martina Angi1,2,
  2. Helen Kalirai1,
  3. Azzam Taktak3,
  4. Rumana Hussain2,
  5. Carl Groenewald2,
  6. Bertil E Damato2,4,
  7. Heinrich Heimann2,
  8. Sarah E Coupland1,5
  1. 1 Department of Clinical and Molecular Cancer Medicine, Liverpool Ocular Oncology Research Group, University of Liverpool, Liverpool, UK
  2. 2 Liverpool Ocular Oncology Centre, St Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
  3. 3 Department of Medical Physics & Clinical Engineering, Royal Liverpool University Hospital, Liverpool, UK
  4. 4 Department of Ophthalmology and Radiation Oncology, Ocular Oncology Service, University of California, San Francisco, California, USA
  5. 5 Department of Cellular Pathology, Royal Liverpool University Hospital, Liverpool, UK
  1. Correspondence to Dr Sarah E Coupland, University of Liverpool, Room 365, 3rd Floor The William Henry Duncan Building, 6 West Derby Street Liverpool, L7 8TX, UK; s.e.coupland{at}liverpool.ac.uk

Abstract

Background Accurate survival prognostication for patients with uveal melanoma (UM) enables effective patient counselling and permits personalised systemic surveillance for the early detection of metastases and, in high-risk patients, enrolment in any trials of systemic adjuvant therapy. The aim of this work is to determine the success of prognostic UM tumour biopsy using an improved surgical approach and optimised sample handling workflow.

Methods Patients with UM treated by primary radiotherapy between 2011 and 2013 and who underwent a prognostic biopsy with cytology, multiplex ligation-dependent probe amplification and/or microsatellite analysis were included. The main outcomes and measures were success of cytology and genetic studies, and surgical complications.

Results The cohort comprised 232 patients with UM having a median age of 59 years (range, 25–82) at treatment. The median largest basal diameter was 11.4 mm (range, 4.1–20.8) and tumour height was 3.4 mm (range, 0.7–10.3). Ciliary body involvement was noted in 42 cases. Treatment consisted of Ru-106 brachytherapy in 151 cases (65%) and proton beam radiotherapy in 81 cases (35%). With improvements in surgical techniques and laboratory methods over time, cytology success increased from 92% (131/142) to 99% (89/90) and the numbers of samples with sufficient DNA for genetic testing increased from 79% (104/131) to 93% (83/89). Overall, chromosome 3 loss was noted in 64/187 (34%) cases. Surgical complications, including transient localised bleeding, vitreous haemorrhage and retinal perforation, decreased over time. Eight patients required additional surgery.

Conclusions Improved surgical techniques and laboratory methods yielded successful cytology and genetic information in the majority of cases.

Precis Analysis of data from 232 patients with uveal melanoma undergoing prognostic tumour biopsy demonstrated that improved surgical techniques and laboratory methods yielded successful cytology and genetic information in 99% and 89% of cases, respectively.

  • uveal melanoma
  • choroidal melanoma
  • biopsy
  • cytology
  • prognostication
  • molecular analysis
  • MLPA
  • MSA
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Footnotes

  • Contributors All of the authors have been involved in the following: substantial contributions to the conception or design of the work; the acquisition, analysis or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy of integrity of any part of the work are appropriately investigated and resolved.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval RLBUHT, Ref 4031-11/129.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with 'BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.

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