The future of diagnostic imaging in retinoblastoma

Abstract

T he treatment of retinoblastoma has evolved from enucleation and external beam radiation therapy (EBRT) to other globe-salvaging therapies, including chemoreduction with focal consolidation and, more recently, superselective intraarterial chemotherapy. Survival rates in the United States have climbed to greater than 99% at specialized centers, with many children preserving the eye and some vision. Management of children with retinoblastoma requires a detailed assessment of the tumor status in both eyes, aided by advances in ophthalmic imaging to investigate and document intraocular findings. The art of retinoblastoma treatment rests on the ocular oncologist’s clinical examination and assessment of relevant imaging to formulate an appropriate treatmentplanwith the child’swell-being and family’swishes in mind. Intraoperative imaging with wide-field photography and echography are complementary approaches commonly employed to aid in the diagnosis and management of these tumors. Wide-field photography (80-130 degrees), usually done using RetCam devices (Clarity Medical Systems, Pleasanton, CA), allows for the acquisition of high-quality retinal images and includes the capability to perform fluorescein angiography as needed for ocular examination to differentiate retinoblastoma from other disease entities. Echography allows for the assessment of subretinal fluid, calcification, or subretinal/vitreous seeds. Additionally, this imaging modality aids in establishing the extent of the tumor in relation to the optic nerve, choroid, sclera, and orbit, changes that may dictate treatment decisions. Unfortunately, currently used imaging modalities cannot detect subtle subretinal fluid, subtle vitreous and subretinal seeds, or early tumor growth/progression. Yet it is imperative to identify the appearance of retinoblastoma tumor changes to make treatment decisions. Recent advances in imaging hold the potential for aiding in earlier detection and possibly leading to enhanced local tumor control and visual potential. The current article by Ramasubramanian and colleagues investigates the findings of 1 of these new modalities: autofluorescence (AF). In this excellent article, the authors present their AF findings on children with treated retinoblastoma. Evaluating 88 tumors in 61 children with a mean age of 10.3 years (youngest, 5.9 years), they found that tumors showed hyperAF of