Is 2-mm Punch Biopsy Useful in the Diagnosis of Malignant Eyelid Tumors?

Abstract

Purpose: Two-millimeter punch biopsy is a swift and practical diagnostic tool in the outpatient setting. However, few studies have evaluated the efficacy of the method for diagnosis of malignant eyelid tumors.Methods: This was an observational study of patients with suspicion of malignant eyelid tumor attending the Ocular Plastic Surgery Center at Hospital das Clínicas, University of São Paulo School of Medicine. Following standard procedures, preoperative biopsies were taken with a 2-mm trephine and surgical excision was performed with safety margins, followed by reconstruction. Anatomopathologic analysis of the surgical specimen was used as gold standard to evaluate the accuracy of diagnosis by punch biopsy.Results: The study included 50 periocular tumors with suspicion of malignancy. The indicators of efficacy in the identification of malignancy by 2-mm punch biopsy were: sensitivity 88%, specificity 100%, positive predictive value 100%, and negative predictive value 64%. Accuracy was 90% for malignancy and 80% for histologic type. The κ index of agreement between the diagnostic methods was 0.722 (p < 0.001).Conclusion: A positive result with 2-mm punch biopsy is a safe indication for surgical excision of the tumor, whereas a negative result does not necessarily imply benignity. In cases of high clinical suspicion, a second biopsy should be taken from a different part of the tumor to rule out malignancy. (Ophthal Plast Reconstr Surg 2012;28:282-285) A pproximately 5% to 10% of all skin neoplasms affect the eyelid. In fact, periocular malignancy is the most common type of neoplasm observed at our service.1 Due to their small size, periocular tumors can be hard to diagnose and surgery is often postponed when clinical findings are ambiguous. Despite considerable accuracy in the diagnosis of malignancy, clinical evaluation of patients with periocular tumors frequently yield false-positive and false-negative results, and on the average clinical and histologic findings are poorly correlated. 2-5Several factors have been associated with recurrence of periocular tumors after treatment, such as size, location, and medical conditions related to histologic type.6 Aggressive tumors require larger surgical margins and pose a greater risk of metastasis.Punch biopsy is a swift and simple diagnostic technique requiring very little equipment or surgical skill. A 2-mm trephine will collect a tissue sample large enough for analysis and no suture is necessary. The level of agreement between punch biopsy, conventional incisional biopsy, and histopathologic analysis of the surgical specimen is high. [7][8][9] Punch biopsy can be useful in preoperative assessments of skin disorders.7 However, the few published studies on punch biopsy in the periocular region-rarely cited by ophthalmologists-lack a complete evaluation of efficacy, especially with regard to histologic type. OBJECTIVEThe aim of this study was to evaluate the ability of 2-mm punch biopsy to diagnose malignancy and define the histologic type of eyelid tumors. MATERI...

Recent Advances in Ophthalmic Plastic Surgery

“…102 Pagetoid spread was present in 39%. 105 A positive result with 2-mm punch biopsy is a safe indication for surgical excision of the tumor, whereas a negative result does not necessarily rule out malignancy. 102 Primary surgical management involved excision with reconstruction (49%), primary exenteration (10%), and Mohs surgery (8%).…”

“…Misdiagnosis of chalazion and pagetoid tumor spread was associated with a significant diagnostic delay. 105 As the quest to minimize the incidence of regional lymph node metastasis intensifies, SLNB is gaining increasing popularity. Only 2% developed metastasis.…”

Oculoplastic aspects of ocular oncology

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“…Porém, pouco se estudou a respeito desse método diagnóstico em lesões palpebrais. (20,21,33) Este estudo avaliou a acurácia da biópsia por trépano de 2 mm em lesões palpebrais, comparando-se um sítio de biópsia com dois sítios.…”

“…Também poupa material cirúrgico e recursos, e pode ser realizada em ambiente ambulatorial e de consultório, todos fatores importantes em serviços médicos em que existe dificuldade no agendamento cirúrgico ou escassez de material. (19,20,22,33) Luiz Angelo Rossato …”