Impression Cytology of Melanocytic Conjunctival Tumors Using the Biopore Membrane

Clinic-pathological agreement in the diagnosis of conjunctival tumours: Analysis of 195 cases

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.

Quantitation of Pax-6 protein in ocular impression cytology samples using an electrochemiluminescence immunoassay

Paired box protein Pax-6 (oculothrombin) is a transcription factor that plays an important regulatory role in ocular, brain, and pancreatic development. Mutations of the PAX6 gene cause aniridia and Peters anomaly. Reduction in Pax-6 protein is also associated with ocular diseases such as dry eye. An electrochemiluminescence immunoassay method using the Meso Scale Discovery platform was developed to measure Pax-6 protein levels in corneal epithelial cells obtained by impression cytology. Impression cytology involves harvesting ocular epithelial cells by applying a polyethersulfone membrane patch briefly to the ocular surface using a commercially available EYEPRIM™ device. The epithelial cells that adhere to the membrane patch of the EYEPRIM™ device provide a biological sample which can be assayed for Pax-6 protein levels. Assay development identified an antibody pair capable of detecting purified recombinant Pax-6 protein produced in mammalian cells. The optimized assay has a dynamic range of 24 pg mL^-1 to 100,000 pg mL^-1 and a lower limit of quantification of 24 pg mL^-1. Assay selectivity was demonstrated using either HeLa or HEK293 cells transfected with inhibitory RNA. Finally, the method was validated by measuring Pax-6 protein levels in impression cytology acquired samples obtained using the EYEPRIM™ device from rabbit cornea.

Impression cytology for detection of clinically suspected ocular surface disorders: A cross-sectional study

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.

Potential utility of dermoscopy in the examination of ocular pigmentations

Background

Dermoscopy is a fundamental method in the examination of melanocytic neoplasms. Limited data exist about the dermoscopic features of ocular pigmentations (OPs).

Objectives

We aimed to investigate the usefulness of dermoscopy in the examination of OPs.

Methods

Dermoscopic images of OPs of 20 consecutive patients were recorded. Impression cytology (IC) was performed to these lesions. Dermoscopic images were evaluated for specific dermoscopic structures and patterns without knowing the cytological examination results.

Results

Fifteen percent (3/20) of the lesions presented with suspicious cytological findings. More of the suspicious lesions had 4 colors compared to benign lesions (66.7% vs 11.8%, p=0.088). This was also determined for blue-gray (66.7% vs 11.8%, p=0.088) and white (66.7% vs 17.7%, p=0.14) colors. At least 3 structures were observed in all suspicious lesions (100%), but were observed in only in 41.2% of benign lesions (p=0.105). Besides, two-thirds of suspicious lesions had more than 4 structures, but none of the benign lesions reported this (p=0.016). Most of the benign lesions showed asymmetry in one axis (93.3%), whereas all suspicious lesions showed asymmetry in 2 axes (p=0.004).

Conclusions

Dermoscopy seems to be a useful method in the evaluation of OPs. The existence of dermoscopic patterns, colors, and dermoscopic structure plurality and asymmetry raise suspicion in OPs, similarly to skin pigmentations. Dermatologists should be aware of the ocular area, and closer collaboration should be developed between dermatologists and ophthalmologists in the management of pigmented lesions.

Impression Cytology in a Series of Clinically Diagnosed Ocular Surface Melanocytic Lesions

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.

Advances in the management of conjunctival melanoma

Malignant melanoma of the conjunctiva is a rare but serious condition. Over the last several years, there have been important advances in the classification, diagnosis, and treatment of this condition. Recent cytogenetic and immunohistochemical studies are increasing understanding of its tumorigenesis. Diagnosis, although still made via histopathology, has been aided with imaging techniques such as ultrasound biomicroscopy and anterior segment optical coherence tomography. Primary treatment consists of surgical excision. But adjuvant treatments with cryotherapy, topical chemotherapy, and radiation therapy have shown increased success. Sentinel lymph node biopsy has shown early promise of detecting micro-metastasis. Long term follow-up of patients with conjunctival melanoma with systemic surveillance is necessary to detect recurrences and metastases.

Impression cytology diagnosis of ulcerative eyelid malignancy

OBJECTIVE

The utility of impression cytology in ocular diseases has predominantly been restricted to the diagnosis of dry eye, limbal stem cell deficiency and conjunctival neoplasias. Its role in malignant eyelid lesions remains largely unexplored. Although scrape cytology is more popular for cutaneous lesions, impression cytology, being non-traumatic, has an advantage in small and delicate areas such as the eyelid. The present study has been designed to evaluate its role in the diagnosis and management of malignant eyelid lesions.

METHODS

Thirty-two histopathologically proven malignant eyelid lesions diagnosed over a 2-year period, including 13 basal cell carcinomas, 11 sebaceous carcinomas, four squamous cell carcinomas, two malignant melanomas and two poorly differentiated carcinomas, formed the study group.

RESULTS

The results of impression cytology were compared with those of histopathology in the study group and with an age- and sex-matched group of benign cases as controls. The sensitivity of impression cytology was 84% (27/32) for the diagnosis of malignancy and 28% (9/32) for categorization of the type of malignancy.

CONCLUSIONS

Impression cytology is a simple, useful, non-invasive technique for the detection of malignant ulcerative eyelid lesions. It is especially useful as a follow-up technique for the detection of recurrences.

Ocular surface tumors

Tumors of the conjunctiva and cornea comprise a large and varied spectrum of conditions. These tumors are grouped into two major categories of congenital and acquired lesions. The acquired lesions are further subdivided based on origin of the mass into surface epithelial, mucoepidermoid, melanocytic, vascular, fibrous, neural, histiocytic, myxoid, myogenic, lipomatous, lymphoid, leukemic, metastatic and secondary tumors. Ocular surface tumors include a variety of neoplasms originating from squamous epithelium, melanocytic tumors and lymphocytic resident cells of the conjunctival stroma. In this review, we highlight clinical features of these lesions, important diagnostic and investigative tools and standard care of management.