View 2019 Abstracts

to investigate the accuracy of suspected clinical and radiologic diagnosis in patients undergoing orbital biopsy procedures.

Data from orbital biopsy patients with available imaging and tissue diagnosis (143 patients) was collected between June 2008 and May 2017 (10 years). The preoperative imaging (CT, MRI) and histopathology reports were compared to clinical diagnosis.

143 patients /149 biopsies were included in the study. The median age was 61 years (0-91). Imaging showed most of orbital masses located extraconal (74.4%).
The clinical diagnosis matched the tissue diagnosis in 55% of biopsies and the imaging diagnosis was correct in 64.4% of cases. The most common tissue diagnosis was non-specific inflammation (30%), followed by lymphomas (23.4%), benign tumours (11.4%) and metastases (10%). A high rate of correct clinical diagnosis was found in lymphomas (85.7%) and metastases (86.6%). They also had the top rate of correct imaging diagnosis (lymphomas 88.5%, metastases (93.3%). Non-specific orbital inflammation was least correctly suspected clinically (31%) and benign tumours radiologically (47%).
Histopathology was nondiagnostic in 12 patients (8.4%). A second biopsy was needed in 6 patients (4.2%), of which 2 were then diagnosed with GPA and 2 with high grade T or B cell lymphoma.

Modern imaging methods (MRI, CT) and use of contrast are effective in locating orbital pathology and aid targeted biopsies, however tissue diagnosis remains the gold standard in orbital lesions. It is reassuring to see that more sinister pathology is better suspected clinically and radiologically, allowing appropriate prioritisation of timing of biopsy.