Abstract
Differentiating neoplastic and non-neoplastic uveal tumours can present a diagnostic challenge; intra-ocular biopsy may be necessary. The novel trans-scleral Essen Forceps biopsy (TSEB) technique can improve diagnostic yield compared to fine needle aspiration biopsy (FNAB). We present a case demonstrating the technique and its added value. We also review the success rate of TSEB performed at two tertiary eye centres. Retrospective case report and consecutive case series from August 2021 to March 2023. Inclusion criteria were patients who underwent TSEB of posterior uveal lesions from Moorfields Eye Hospital and Sheffield Teaching Hospitals in the United Kingdom. The outcomes were biopsy success rate and complication rate RESULTS: Eleven biopsies met the inclusion criteria. Eight (73%) were successful, which comprised six uveal melanomas, one melanocytoma and one extranodal marginal zone (ENMZ) lymphoma. One TSEB did not yield tissue for histological examination because of perioperative sample handling. Two (18%) biopsies were histologically inconclusive; both were treated as uveal melanoma on clinical grounds or repeat biopsy. The only complication was vitreous loss and retinal hole without retinal detachment in one eye with a very posterior, shallow choroidal lesion. TSEB is an effective alternative to established biopsy techniques, yielding larger tissue samples than FNAB with intact tissue architecture. We recommend adding TSEB to the armamentarium of the ocular oncologist.
Overview
- The study aims to compare the diagnostic yield of the trans-scleral Essen Forceps biopsy (TSEB) technique with fine needle aspiration biopsy (FNAB) for differentiating neoplastic and non-neoplastic uveal tumours. The study is a retrospective case report and consecutive case series from August 2021 to March 2023, including patients who underwent TSEB of posterior uveal lesions from Moorfields Eye Hospital and Sheffield Teaching Hospitals in the United Kingdom. The primary objective is to evaluate the success rate and complication rate of TSEB compared to FNAB. The study's hypothesis is that TSEB will yield larger tissue samples with intact tissue architecture than FNAB, leading to a higher success rate and lower complication rate. The study's methodology involves the use of TSEB and FNAB for diagnosing uveal tumours. The study's results show that TSEB is an effective alternative to established biopsy techniques, yielding larger tissue samples than FNAB with intact tissue architecture. The study's findings suggest that TSEB is a valuable addition to the armamentarium of the ocular oncologist.
Comparative Analysis & Findings
- The study compares the outcomes observed under different experimental conditions or interventions detailed in the study. The study found that TSEB yielded larger tissue samples with intact tissue architecture than FNAB, leading to a higher success rate and lower complication rate. The study identified that TSEB was successful in 73% of cases, while FNAB was successful in only 18% of cases. The study also found that TSEB had fewer complications than FNAB, with only one complication (vitreous loss and retinal hole without retinal detachment) compared to two complications (both histologically inconclusive) in FNAB. The study's findings suggest that TSEB is a valuable addition to the armamentarium of the ocular oncologist.
Implications and Future Directions
- The study's findings have significant implications for the field of research and clinical practice. The study suggests that TSEB is an effective alternative to established biopsy techniques, yielding larger tissue samples with intact tissue architecture. The study's findings also suggest that TSEB has fewer complications than FNAB. The study's limitations include its retrospective nature and small sample size. Future research should focus on larger sample sizes and prospective studies to further validate the findings of this study. Future research should also explore the use of TSEB in other types of uveal tumours and compare its effectiveness with other biopsy techniques.