眼内活检手术在非典型性眼内病变诊断中的应用

Application of intraocular biopsy in the diagnosis of atypical intraocular lesions

目的 评价眼内活检手术在非典型性眼内病变诊断中的应用价值.方法 回顾分析经临床特征及多种非侵人性检查难以确定眼内病变性质而行前房穿刺抽吸、玻璃体穿刺抽吸、玻璃体内切除小块病变活检手术的31例患者31只眼的临床资料.对所有抽取液体或病变组织立即行细胞学检查,统计分析活检取材次数、组织细胞检出率和病理独立诊断率.观察活检手术中和手术后并发症发生情况.对活检诊断送检材料为恶性并随后摘除眼球者再给予组织病理检查,分析眼内活检手术在恶性肿瘤诊断中的敏感性和特异性、阳性及阴性预测价值.结果 31只眼共取材活检35次,其中29只眼经31次取材活检检出病变组织,检出率为88.6%.31只眼中,恶性眼内病变12只眼,占38.7%;良性眼内病变15只眼,占48.3%%;先诊断为良性眼内病变,经再次活检诊断为恶性眼内病变2只眼,占6.5%;无法定性诊断2只眼,占6.5%.经31次取材活检检出病变组织的29只眼中,病理独立诊断23只眼,取材活检25次;病理结合临床再诊断6只眼,取材活检6次;病理独立诊断率为71.4%.眼内活检手术中眼内出血5只眼;手术后视网膜脱离3只眼;炎症加重1只眼.眼内活检手术对恶性肿瘤诊断的敏感性为85.7%,特异性为100.0%,阳性预测价值为100.0%,阴性预测价值为86.7%.结论 眼内活检手术在非典型性眼内病变诊断中有重要的应用价值.

Objective To evaluate the application value of intraocular biopsy in the diagnosis of atypical intraocular lesions. Methods The clinical data of 31 patients （31 eyes） with atypical intraocular lesions were retrospectively analyzed. All patients received intraocular biopsy including anterior chamber puncture, vitreous puncture and vitreous biopsy followed by pathological cell examination. Cytological examination was immediately performed for all biopsy fluids or tissues;biopsy times, the positive detecting rate and independent pathological diagnosis rate were analyzed. Intraoperative and postoperative complications were observed. Eyeballs with biopsy-suggested malignancy lesions were enucleated and underwent histopathological analysis. The biopsy results and histopathological results were compared and analyzed. Result Thirty-one eyes received 35 times of biopsy operation in total. The available samples harvested from 29 patients through 31 operations were valid for pathological cell examination, the positive detecting rate was 88.6%. Among the 31 eyes, 12 eyes had malignant lesions;15 eyes had benign lesions;two eyes were diagnosed with benign lesions initially, but corrected to malignant through the second biopsy;the lesions in two eyes were not determined by biopsy. Among the 29 eyes with valid biopsy, 23 eyes were diagnosed independently by pathological examination;the diagnosis of the other six eyes was made based on pathological examination and clinical features. The independent pathological diagnosis rate was 71.4%. The complications included intraocular bleeding in five eyes, retinal detachment in three eyes and more serous inflammation in one eye. The sensitivity for diagnosis of malignant lesions was 85.7% and the specificity was 100.0%. The predictive value of positive test was 100.0% and the negative one was 86.7%.Conclusion Intraocular biopsy has important values in the diagnosis of atypical intraocular lesions.