Fine Needle Aspiration Cytology of Orbital and Ocular Adnexal Lesions.

Abstract

Fine needle aspiration cytology (FNAC) of orbital tumors as a rapid and minimally invasive diagnostic technique backs to 1975 [1] and since then it was widely used as a primary investigative procedure for the diagnosis and management of various orbital and eyelid lesions. [2] This technique when performed in experienced hands is safe and of great value in the diagnosis of new primary, recurrent, and metastatic orbital tumors. [2‑4] Moreover, it provides the considerable advantages to both patient and orbital surgeon in terms of shortening the hospitalization period, reduction of health care costs, and proper management of orbital lesions. [3] The reported diagnostic accuracy of this technique for orbital and adnexal lesions ranged from 47% to 100% and its diagnostic value has been increased with the help of various ancillary methods. [2,3,5‑10] In a series by Nag et al, [11] the sensitivity and specificity of FNAC in the diagnosis of orbital lesions was 86.6% and 100%, respectively. Although no major surgical intervention should be planned only based on FNAC results, this technique can be beneficial for planning further medical or limited surgical management of the orbital and adnexal lesions. [2,3] Moreover, if FNAC results are interpreted in the light of clinical history, clinical features, and imaging appearances of the lesion, they may eliminate the subsequent need for incisional or excisional biopsy. [12] Effective FNAC results will be obtained by a proper teamwork between an orbital surgeon expert in the procedure technique and a cytopathologist experienced in orbital pathology. [2,10,13] Potential pitfalls of FNAC of orbital lesions include (i) lack of enthusiasm for performing FNAC due to orbital structural complexity and fear of globe and optic nerve injuries; (ii) absence of an experienced cytopathologist as well as challenges faced with in the diagnosis of extreme heterogeneity of lesions occurring in the orbit and ocular adnexa; and (iii) challenges in sampling deep‑seated retrobulbar lesions, lymphoid lesions, and highly fibrotic tumors which affects the accuracy of FNAC. [7,10,13‑15] Comprehensive awareness from such issues ahead appears required to minimize the risks and