Ultrasound-guided core-needle biopsy of extra-ocular orbital lesions

Objective

To evaluate the diagnostic yield of ultrasound-guided core-needle biopsy of extra-ocular orbital lesions.

Methods

Fifty-five patients with monolateral exophthalmos prospectively underwent computed tomography (CT) to investigate the presence of an extra-ocular mass (n?=?25). Excluding benign lesions (n?=?7) and patients in whom CT revealed an unknown primitive malignancy (n?=?5), 13 patients (7 male, 6 female; mean age 62?±?16 years) underwent ultrasound. Lesion appearance (echotexture, power Doppler vascularisation), size, position with respect to the cone and to the globe were recorded. Ultrasound-guided biopsies were performed (automatic, n?=?9; semi-automatic 18-G needle, n?=?4). Sample adequacy and complication rate were recorded.

Results

Ultrasound demonstrated hypoechoic lesions with mild power Doppler vascularity, that were completely (n?=?7) or partially extra-conal (n?=?6), located laterally (n?=?8) or posteriorly (n?=?5) to the globe. Mean size was 3.25 cm. All biopsies yielded adequate material for histological and immunohistochemical analysis (nine non-Hodgkin’s lymphomas, two adenocarcinomas, one lymphoid hyperplasia, one inflammatory pseudotumour). Complications included cutaneous eyelid haematoma (n?=?3) and retro-bulbar haematoma (n?=?1), treated conservatively and resolved at 10-day follow-up. No immediate or delayed vision reduction was reported.

Conclusions

Ultrasound-guided core-needle biopsy of extra-ocular orbital lesions is feasible and accurate, being free from long-term complications. This procedure provided 100 % adequate samples to achieve final diagnosis.

Key Points

? Ultrasound-guided core-needle biopsy of extra-ocular orbital lesions seems feasible and accurate. ? In this series it provided a final diagnosis in 13/13 cases. ? It appears free from long-term complications. ? It provides immunohistochemical analysis of the specimen. ? It should represent a valuable alternative to surgical biopsy.