How accurate is the clinical and radiological evaluation of orbital lesions in comparison to surgical orbital biopsy?

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The purpose of the present study is to determine the overall and disease-related accuracy of clinical and radiological diagnosis when compared to the histology result of the surgical orbital biopsy. A retrospective case notes analysis of patients who underwent surgical orbital biopsy during a 12-year period involving more than 100 orbital lesions. The accuracy of clinical and radiological diagnosis was compared with histological diagnosis. A total of 112 orbital biopsies were carried out in 104 eyes of 101 patients between 2003 and 2015. Correct diagnosis was reached in <50% of cases by both ophthalmologists and radiologists alike. Vascular lesions exhibit characteristic clinical and imaging features that allow for accurate diagnosis and can often be managed conservatively. The greatest challenge, both clinically and on imaging was in differentiating between inflammatory and haematological orbital lesions which represented half of our cases. There was no operative mortality and there were no post-operative complications recorded. Surgical orbital biopsy is a safe and accurate diagnostic tool for orbital lesions of unknown aetiology and, in our opinion, remains the gold standard.