CHAPTER 10 FNA ORBITAL LESIONS

Fine Needle Aspiration of Orbital and Periorbital Lesions

In this chapter, cytologic findings in orbital fine needle aspiration are illustrated. The general pathologists and cytopathologists who are skilled in interpretation of extra-orbital fine needle aspirates will readily transfer that expertise to orbital aspirates because the tumors are similar. Accuracy in differentiating benign and malignant orbital lesions by aspiration cytology varies from 50% to 100% in previous series. [1, 2] The utility of fine needle aspiration is determined by how the results will affect patient management. If patient management is unaffected, then the procedure is not necessary. For example, certain orbital tumors are removed completely during the first operation (mixed tumor of lacrimal gland, schwannoma, dermoid cyst, and cavernous hemangioma). If the clinical diagnosis of these lesions is certain prior to the operation, then fine needle biopsy is not required. However, the clinical and radiologic diagnoses are frequently wrong (over 50% of cases in one series) and fine needle aspiration has been useful. [3] There are two general indications in which fine needle aspiration of the orbit has proven most useful. First, if the suspected tumor can be treated without surgical intervention (e.g., rhabdomyosarcoma, sarcoidosis, metastatic cancer, reactive lymphoid hyperplasia, lymphoma, sclerosing orbititis, and infections), an accurate fine needle biopsy may spare the patient any further procedure. Second, fine needle aspiration may help surgeon plan an operation. For example, a patient with the erroneous clinical or radiologic diagnosis of osteosarcoma might have a planned radial orbitectomy changed to an appropriate curettage if a fine needle aspiration biopsy reveals eosinophilic granuloma. In addition, the fine needle biopsy may radically change a medical evaluation for metastatic disease. The patient with a suspected lymphoma requires a different evaluation than the patient with granulomatous disease.

References:
1. Krohel GB, Tobin D, Chavis RM. Inaccuracy of orbital fine needle aspiration biopsy. Ophthalmology 1984[Suppl.];91:83.
2. Czerniak B, Woyke S, Daniel B, Krzysztolik Z, Koss LG. Cancer 1984;54:2385-2389.
3. Glasgow BJ, Layfield LJ. Daign Cytopathol 1991;7:132-141.

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