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To evaluate the usefulness of core needle biopsy of orbital masses under computed tomography (CT) guidance.

We retrospectively reviewed the medical records of patients who received this procedure. The procedure was performed under local anaesthesia on a day case basis. A peribulbar block was administered 15 minutes prior to the procedure. An initial non-contrast CT was performed through the orbits to allow localisation of the mass. A reference light was used to illuminate the plane of the optimal slice. A 6 cm 18G Temno Evolution semi-automated biopsy needle held by a pair of long locking Rampley sponge forceps was inserted through the skin into the orbit. Prior to further advancement of the needle a low-dose CT limited to the previously determined plane was performed to confirm its position. The needle was then advanced, and the cutting needle was deployed to obtain the biopsy.

Five patients were identified. They all had several comorbidities that rendered orbitotomy and general anesthesia risky. The core needle biopsy was successful in 4 patients in whom it revealed: metastatic prostate adenocarcinoma, diffuse large B cell lymphoma, metastatic neuroendocrine tumour, and fibroinflammatory process. The biopsy failed in the fifth patient when the needle failed to penetrate the tumour despite good localization on CT. He eventually was diagnosed with fibrous meningioma. None of the patients had any complications.

CT-guided core needle biopsy of an orbital mass is safe and effective in obtaining tissue for diagnosis. It is less successful in tumours of a hard consistency. It avoids major surgery and allows the use of radiotherapy, if needed, immediately after biopsy.