Differential diagnosis of intraocular neoplasms with ultrasonography

doi:10.1016/0301-5629(85)90019-5

Ultrasound in Medicine & Biology

Volume 11, Issue 1, January–February 1985, Pages 163-170

https://doi.org/10.1016/0301-5629(85)90019-5 Get rights and content

Abstract

In the past five years A- and B-mode echography were used in the differential diagnosis of intraocular tumours (174 patients) and numerous cases with mimicking lesions. By using the 7200 A-scan equipment and distinct investigation techniques and giving attention to all aspects (quantitative, kinetic, and topographic) of the obtained echogram, the detection of the tumours involved in this study (choroidal melanoma, choroidal hemangioma, choroidal metastases, and retinoblastoma), is almost 99%. The accuracy in the differentiation of these tumours appears to be over 90%. Most of the false positives occur in the' differentiation between choroidal melanomas and choroidal metastases.

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Intraocular tumors involving the choroid are both rare and highly diverse. As a result, the diagnosis and management of these tumors can be challenging. Classically, a variety of techniques have been used to evaluate choroidal tumors, including indirect ophthalmoscopy, intravenous fluorescein angiography, indocyanine-green angiography, autofluorescence, ultrasound, magnetic-resonance imaging, computed tomography scanning, and even fine-needle aspiration biopsy. Optical coherence tomography (OCT) is a new and rapidly-evolving noninvasive imaging technique that provides important information on the posterior pole retinal layers and the choroid. OCT has many applications, but it is especially useful in assessing choroidal tumors because it permits in-vivo quantification of the tumor shape and provides accurate measurements of the dimensions and details of intratumoral tissue. Moreover, OCT provides detailed images of the surrounding retina and choroid; these images are so vivid that they resemble histopathological assessment, thus providing an in-vivo ‘optical biopsy’ of the tumor, retina, and choroid. In this chapter, we describe the major techniques for the differential diagnosis of choroidal tumors, with a particular emphasis on OCT.
Ocular metastasis of lung adenocarcinoma with ELM4-ALK translocation: A case report with a review of the literature
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Citation Excerpt :
Ultrasonography differentiates between choroidal melanoma, metastasis, and hemangioma with 90% accuracy.12 Metastatic lesions are usually hyperechogenic as compared to uveal melanoma on A-mode.12 FAF may be used to aid in the evaluation of the tumor margin.13
Choroidal metastasis is the most common intraocular neoplasm and is associated with significant morbidity. In a small percentage of patients, ocular manifestation may be the initial presentation of a systemic malignancy and can be diagnostically difficult to distinguish from ocular primary malignancies. Herein, we present a case of a never-smoker whose ocular pathology was integral to the diagnosis and management of a lung adenocarcinoma harboring a rare oncogene. Through this case, we have explored important diagnostic and therapeutic considerations of pulmonary metastases to the choroid.
Mushroom-shaped choroidal hemangioma
1996, American Journal of Ophthalmology
We examined the clinicopathologic features of a mushrooni'shaped choroidal tumor that originated in the right eye of a 13-year-old girl.
The clinical, ultrasonographic, and histopathologic features of the enucleated eye were studied.
On clinical examination, the choroidal tumor appeared mushroom-shaped with ultrasonic characteristics of high internal reflectivity and choroidal excavation. The enucleation specimen contained a cavernous hemangioma that extended through Bruch's membrane.
Choroidal hemangioma may extend through Bruch's membrane and be mushroom shaped.
Echographic differentiation of histological types of intraocular melanoma
1991, Ultrasound in Medicine and Biology
The aim of this study was to assess the differentiation of histologically different types of choroidal melanomas by means of clinical and quantitative acoustic/texture parameters of echograms. Clinical parameters were graded by morphological, kinetic and quantitative statements about the A- and B-mode echograms by a skilled diagnostician. Acoustic/texture parameters were obtained by processing and analysing radio frequency, AM-demodulated and FM-demodulated echograms. The data were preprocessed to remove influences induced by beam diffraction and focusing. The correlations between the clinical parameters were lower than 0.5 but significant in a few cases. The best set of four clinical echographic parameters enabled a retrospective classification of spindle type melanomas vs. mixed + epithelioid type melanomas with an accuracy of 77% (area under the ROC-curve of 86%). These figures do not enable, however, a prospective diagnosis. The correlations of the clinical parameters with the acoustic/texture parameters were investigated. The mutual correlations between the latter parameters were also assessed, the most significant (0.70) being between the speckle size and the slope of the linearized backscattering spectrum. The discriminant analysis performed with the best four acoustic/texture parameters (n = 30) yielded a sensitivity of 89%, a specificity of 92% and an area under the ROC-curve corresponding to a probability of correct classification of 96.6%. When using these data prospectively to classify tumours of unknown cell type (n = 21), this classification could be performed in 86% of cases.
Ultrasonic Differentiation of Intraocular Melanomas: Parameters and Estimation Methods
1991, Ultrasonic Imaging
In this study, the estimation of ultrasound parameters in evaluated for in vivo differentiation of intraocular melanomas. For this purpose, both tissue and image parameters of the ultrasound signal are considered. These parameters comprised, respectively, the frequency dependent attenuation and backscattering coefficient of the melanoma tissue, and the first and second-order statistics of the amplitude-modulated and phase-derivative images of the melanomas.
A diffraction correction procedure has been applied prior to the estimation of the parameters to correct the ultrasound signals for the echographic equipment used and for the various distances of the region-of-interest to the transducer. In addition, a preprocessing to select a homogeneous region from the tumours was implemented to obtain consistent estimates of the ultrasound parameters, because the accuracy and the precision of the parameters would be greatly reduced by the inhomogeneity of the melanoma tissue.
The estimation methods are evaluated by means of the accuracy and precision of the parameters estimated from simulated ultrasound data and data obtained from a tissue-mimicking phantom. The mutual correlations of the parameters are discussed for the ultrasound data obtained from the melanomas.
This study enabled a preselection of the independent ultrasound parameters that could be used in a discriminant analysis to perform a differentiation of intraocular melanomas. The sensitivity and specificity of differentiating spindle cell type from mixed-epitheloid meleanomas were 92 and 89 percent, respectively.
In vivo ultrasound backscattering estimation for tumour diagnosis: An animal study
1989, Ultrasound in Medicine and Biology
In this study the efficacy of a quantitative analysis of backscattered ultrasound for the differential diagnosis of intraocular tumours is tested. The data acquisition was performed with an on-line acquisition and processing system for in vivo work. The backscattering spectra were corrected for the beam effects (diffraction and focussing). The measurements were taken from an animal model (rabbit) in which a Greene's amelanotic melanoma was implanted in the anterior chamber of the eye. The special histologic arrangement of this tumour makes it optimally suited to an assessment of the correlation between histology and backscattering cross section. Various backscattering models were considered theoretically and the choice for a practical testing was motivated on the properties of the observed backscattering spectra. We conclude that the backscattering model based on an “inhomogeneous continuum” with a cylindrical Gaussian autocorrelation function fits the data optimally. The relatively low correlation of the backscattering cross-sections to histology cannot yet be fully explained. The range of acoustic scatterer sizes, however, corresponds quite well to the dimension of observed and quantified histologic structures.

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Clinical supplementDifferential diagnosis of intraocular neoplasms with ultrasonography

Abstract

Surv. Ophthalmol.

Bibl. Ophthalmol.

Disciform macular degeneration with subpigmentepithelial hematoma

Arch. Ophthalmol.

The misdiagnosed choroidal melanoma

Can. J. Ophthalmol.

Ein Tuberkulom der Aderhaut, ein Melanom vortauschend

Klin. Mbl. Augenheilk.

Ophthalmic Contact B-scan Ultrasonography

Der EinfluB neuer Untersuchungsmethoden auf die Diagnostik intraokularer tumorverdächtiger Veränderungen

Klin. Monatsbl. Augenheilk.

Measurement of equipment sensitivity in diagnostic ultrasonography

Special techniques

Adenoma of the pigmentepithelium of the ciliary body simulating a malignant melanoma

Am. J. Ophthalmol.

Ultrasonic diagnosis of tumours of the choroid

Arch. Ophthalm.

Low reflective choroidal metastatic tumour

Lesions mistaken for malignant melanoma of the posterior uvea

Arch. Ophthalmol.

Echography and histological studies in various eye conditions

Arch. Ophthalmol.

Ultrasonographic features of choroidal malignant melanomas

Arch. Ophthalmol.

Clinical supplement
Differential diagnosis of intraocular neoplasms with ultrasonography