Safety and outcome of transscleral fine-needle aspiration biopsy in uveal melanoma: 10-year experience in 347 cases.

Abstract

To report safety outcomes of transscleral fine-needle aspiration biopsy (FNAB) followed by irradiation for uveal melanoma (UM) in a tertiary ocular oncology center over 10 years, and assess whether FNAB modified the overall prognosis of patients treated for primary UM. Patients treated for UM between 2009 and 2020, eligible for conservative treatments by proton beam radiotherapy or Iodine-125 brachytherapy and to FNAB performed prior to UM treatment (tumor thickness 5-10 mm), were included retrospectively. Patients who underwent FNAB were compared to non-biopsied UM controls with similar characteristics, matched 1:1 using a propensity score. Complication rates, including local intraocular and extraocular relapse; metastases; and overall survival, were analyzed. Among 2,813 UM cases, 347 cases who underwent FNAB were matched to 347 controls. Median follow-up was 6.1 years (min=0.2-max=13.3). There was no difference in overall survival (OS) (p=0.25) and metastasis-free interval (MFI, p=0.68). Twenty-four cases (6.9%) and seventeen controls (4.9%) developed local intraocular recurrence (p=0.46). Extraocular relapses occurred in five cases (1.4%) and one control (0.3%), showing no statistical difference (p=0.12). Patients with monosomy 3 and chromosome 8 gain had significantly worse OS and MFI compared to those with normal 3 and 8 chromosomes, and to a lesser extent to those with either chromosomal alteration (p<0.0001). Those with monosomy 3 and chromosome 8 gain experienced more local recurrences (p=0.013). FNAB appears safe in terms of extraocular relapses, OS or MFI, but over the 2009-2020 period, accessing to primary UM somatic genetic features did not improve patient prognosis.