Fine needle aspiration biopsy in selecting treatment for inconclusive intraocular disease

Purpose: To evaluate the fine needle aspiration biopsy (FNAB) as a diagnost ic tool in cases where it was impossible to make a definitive diagnosis wit h noninvasive techniques. Method: 80 consecutive patients with inconclusive diagnoses were examined b y FNAB prior to decision of treatment. Biopsies were performed through a tr ansscleral route in 50 eyes, an anterior chamber route in 16 eyes and a tra nsvitreal approach in 14 eyes. The consequences of FNAB were analysed retro spectively. Results: FNAB confirmed malignancy in 59 eyes. Inconclusive material was ob tained from 5 eyes judged clinically to be malignant disorders. One melanom a was misinterpreted as being a metastasis. In 47.5% of our patients this p rocedure altered the therapeutic plan and 25 patients were spared enucleati on. The biopsy material was correctly diagnosed as benign in 16 cases. Conclusion: In eyes where the diagnosis remained uncertain after non-invasi ve tests, FNAB gave important information which greatly influenced our choi ce of treatment. FNAB contained sufficient tissue elements for cytological diagnosis in 77 eyes. Cytopathological interpretation failed once in relati on to tumour type. The procedure of FNAB can be recommended for use in ambiguous tumour cases of the eye. Probably it should only be used in tumour centres with adequate cytology service.