How accurate is the clinical and radiological evaluation of orbital lesions in comparison to surgical orbital biopsy?

Koukkoulli, Antigoni; Pilling, Joshua D.; Patatas, Kyriacos; El-Hindy, Nabil; Chang, Bernard; Kalantzis, George

doi:10.1038/s41433-018-0078-3

Cited by 17 publications

(35 citation statements)

References 14 publications

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“…In their series of 40 patients, even in those where the correct diagnosis was specified, 22% had alternatives proposed. 5 The other quantitative analysis techniques for radiological images include magnetic resonance spectroscopy and diffusion imaging. 5 Bahl et al 23 or STIR signals and disease activity or therapy responses.…”

Section: Resultsmentioning

confidence: 99%

“…5 The other quantitative analysis techniques for radiological images include magnetic resonance spectroscopy and diffusion imaging. 5 Bahl et al 23 or STIR signals and disease activity or therapy responses. [26][27][28][29] Other quantitative MRI studies include the assessment of signal intensities on T2-weighted images or STIR in patients with optic neuritis [30][31][32] and apparent diffusion coefficient (ADC) measurement of the lacrimal gland in Sjögren's syndrome.…”

Section: Resultsmentioning

confidence: 99%

“…3,4 In a recent study by Koukkoulli et al, a correct diagnosis on orbital tumours was achieved in <50% of cases by both ophthalmologists and radiologists alike before a histological diagnosis was made. 5 The imaging reports are in concordance with histology in only 30% of cases and more than three-quarters of all orbital biopsies were done only for diagnostic purposes. 5 In their MRI study on breast cancers, Holli et al concluded that although the location of the lesion and its margins can usually be determined, the histopathology of the lesions may be difficult to characterise by conventional MRI alone and additional tools are needed for accurate diagnosis.…”

mentioning

confidence: 95%

“…5 The imaging reports are in concordance with histology in only 30% of cases and more than three-quarters of all orbital biopsies were done only for diagnostic purposes. 5 In their MRI study on breast cancers, Holli et al concluded that although the location of the lesion and its margins can usually be determined, the histopathology of the lesions may be difficult to characterise by conventional MRI alone and additional tools are needed for accurate diagnosis. irregular, coarse or fine, with additional features such as brightness, colour, slope, uniformity, density, linearity, frequency, phase, directionality, randomness and granulation.…”

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confidence: 95%

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Non-invasive Classification of Orbital Tissue Pathology Based on Texture Analysis Parameters from Magnetic Resonance Images

Jyothi¹,

Mir²,

Salvage³

et al. 2018

European Ophthalmic Review

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Introduction: This proof-of-concept study aims to demonstrate that quantitative texture analysis of magnetic resonance imaging (MRI) of orbital tumours can produce a unique footprint as an adjunct to histology and as a reference guide. Methods: ‘MaZda’ texture analysis software programme version 4.6 and MedCalc software (18.10.2) were used for data procuring and analysis. The following statistical analyses were performed: analysis of variance (ANOVA) to compare histogram means; Wilcoxon signed rank sum test to compare intra-lesion variability; Mann-Whitney U test to compare inter-lesion feature differences; area under curve to test sensitivity and specificity in differentiating abnormal from normal tissue; and Fisher’s coefficient and linear discriminant analysis to reduce data vector dimensions. Results: Thirteen cases were assessed. Eleven cases were imaged with similar protocols. The software produced characteristic histograms and other quantitative parameters for a variety of orbital pathologies. The mean of histograms differed significantly between pathologies as well as other texture features and there were significant minimal misclassifications on inter-tumour analysis. Though the test showed 100% sensitivity in detecting abnormal tissues, it was not specific in differentiating some of the adnexal normal tissues from certain types of orbital tumours. Conclusions: This proof-of-concept study confirms that the non-invasive classification of orbital tumours is achievable. Further studies are needed to create a larger reference framework.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 95%

mentioning

confidence: 95%

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Non-invasive Classification of Orbital Tissue Pathology Based on Texture Analysis Parameters from Magnetic Resonance Images

Jyothi¹,

Mir²,

Salvage³

et al. 2018

European Ophthalmic Review

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“…Orbital lesions can be grouped under six general categories: inflammatory, infectious, vascular, neoplastic, metastatic (or secondarily invading), and developmental [ 1 ]. Whereas some entities—particularly vascular orbital lesions such as capillary hemangioma—may feature unique characteristics on imaging, most others share clinical and radiographic features, which complicates the establishment of a definitive diagnosis [ 1 – 3 ]. Distinguishing between inflammatory masses and hematological lesions (in particular, lymphoma) based solely on clinical and radiographic findings is especially difficult [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Orbital Rosai-Dorfman disease initially diagnosed as IgG4-related disease: a case report

Iyengar¹,

Golub

McQuinn³

et al. 2020

acta neuropathol commun

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Inflammatory orbital lesions include a broad list of diagnoses, many of them with overlapping clinical and radiographic features. They often present a diagnostic conundrum, even to the most experienced orbital specialist, thus placing considerable weight on surgical biopsy and histopathological analysis. However, histopathological diagnosis is also inherently challenging due to the rarity of these lesions and the overlaps in histologic appearance among distinct disease entities. We herein present the case of an adolescent male with a subacutely progressive orbital mass that generated a significant diagnostic dilemma. Early orbital biopsy was consistent with a benign fibro-inflammatory lesion, but corticosteroid therapy was ineffective in halting disease progression. After an initial substantial surgical debulking, histopathological analysis revealed several key features consistent with IgG4-related disease (IgG4-RD), a systemic fibro-inflammatory process typically accompanied by multifocal tumor-like lesions. Surprisingly, within months, there was clear evidence of clinical and radiographic disease progression despite second-line rituximab treatment, prompting a second surgical debulking. This final specimen displayed distinctive features of Rosai-Dorfman disease (RDD), a systemic inflammatory disease characterized by uncontrolled histiocytic proliferation. Interestingly, certain features of this re-excision specimen were still reminiscent of IgG4-RD, which not only reflects the difficulty in differentiating RDD from IgG4-RD in select cases, but also illustrates that these diagnoses may exist along a spectrum that likely reflects a common underlying pathogenetic mechanism. This case emphasizes the importance of surgical biopsy or resection and histopathological analysis in diagnosing—and, ultimately, treating—rare, systemic inflammatory diseases involving the orbit, and, furthermore, highlights the shared histopathological features between RDD and IgG4-RD.

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Imaging of the Orbit: “Current Concepts”

de Win

2023

Surgery in and Around the Orbit

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Orbital imaging with CT or MRI can be essential in the evaluation of many orbital conditions. Because of its superior bony characterization and fast acquisition, CT is imaging method of first choice in urgent situations like trauma, infection, and evaluation of lesions arising from the orbital wall. Through recent years, CT has also gained a prominent role in (pre)operative planning and navigation, especially through the development of postprocessing software. For the evaluation of more complex orbital disease, MRI is the preferred modality. With its superior soft-tissue differentiation, MRI is useful for determining the extent of orbital lesions, like inflammatory disease, vascular malformations, and orbital tumors. By adding functional MRI techniques, like diffusion and perfusion-weighted imaging, and by combining parameters of different imaging techniques in multiparametric imaging, it is possible to further improve characterization of orbital lesions. In this chapter, the optimal approach to orbital imaging is described, combining knowledge of orbital imaging techniques and imaging indications, together with a structured way of reviewing the orbital images, knowledge of radiological features of common, and more uncommon orbital pathology, and integrating this with the clinical features of the patient.

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How accurate is the clinical and radiological evaluation of orbital lesions in comparison to surgical orbital biopsy?

Abstract: Surgical orbital biopsy is a safe and accurate diagnostic tool for orbital lesions of unknown aetiology and, in our opinion, remains the gold standard.

Cited by 17 publications

References 14 publications

Non-invasive Classification of Orbital Tissue Pathology Based on Texture Analysis Parameters from Magnetic Resonance Images

Non-invasive Classification of Orbital Tissue Pathology Based on Texture Analysis Parameters from Magnetic Resonance Images

Orbital Rosai-Dorfman disease initially diagnosed as IgG4-related disease: a case report

Imaging of the Orbit: “Current Concepts”

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