Diagnostic contribution of ocular imaging techniques in a multimodal diagnostic approach of small pigmented choroidal tumors

Abstract

AbstractPurpose The differential diagnosis of small pigmented choroidal tumors is based on the evaluation of the tumor diameter, thickness, retinal detachment, pigment epithelium changes, and possible associated symptoms.Methods The diagnostic contribution of color fundus photography, fluorescein angiography (FA), indocyanine green angiography (ICGA), fundus autofluorescence (FAF) and optical coherence tomography (OCT), was analyzed in 85 eyes with a small pigmented choroidal tumors, measuring 2‐10 mm in diameter and 0.8‐2.5 mm in thickness. The presumed diagnosis was a large choroidal nevus in 60 cases (71%), and a small choroidal melanoma in 25 cases (29%). The identification of the tumor border, the presence of any retinal detachment on the tumor surface or outside the tumor borders, the presence of orange pigment, drusen, pigment epithelium changes and/or pin points were analyzed on each imaging technique.Results The highest identification score for the tumor margins was reached by color fundus photography. An associated retinal detachment was best identified on OCT. Orange pigment was best detected on fundus color photography and then by FAF. Drusen identification reached the same score on fundus color photography and FA. The appearance of pin points was exclusively seen on FA. Pigment epithelium changes showed the best score on FAF.Conclusion The majority of the investigated ocular imaging techniques played an important role in the identification of diagnostic elements that contribute to the distinction between a small choroidal melanoma and a large nevus. Multimodal imaging techniques have to be used in order to obtain a higher efficacy in differentiating small pigmented choroidal tumors.