Bradford Scott McCrary MD, PhD, Presenter: Nothing to Disclose

Kristen Lem Mygdal MD, Abstract Co-Author: Nothing to Disclose

Troy Wayne Kerby MD, Abstract Co-Author: Nothing to Disclose

Donald Alan Eckard MD, Abstract Co-Author: Nothing to Disclose

Philip Lee Johnson MD, Abstract Co-Author: Nothing to Disclose

Thomas J Whittaker MD, Abstract Co-Author: Nothing to Disclose

Although CT-guided biopsy is widely used throughout the body, there are very few reports of CT-guided orbit biopsy. We describe our experience using CT-guided biopsy for orbital lesions. The technical factors unique to orbital biopsy are detailed. Preferred biopsy approaches are lesion site-specific. Each location (i.e. medial, lateral, intraconal, etc.) presents particular challenges and risks. Specific techniques to avoid complications and the controversial use of local anesthetics are discussed.

MATERIALS AND METHODS:We performed CT guided fine needle aspiration biopsy (FNAB) of orbital masses on eight patients over 15 months. The patients presented with proptosis (3), mass (2), pain (2), proptosis and diplopia (1), and diplopia (1). There were 7 males and 1 female, and the average age of the patients was 63 years. One of the patients had undergone previous attempted surgical biopsy. Pre-biopsy CT scans were obtained on all patients. Lesions were localized to the intraconal, lateral, medial, superior, and inferior aspects of the orbit to ascertain pre-biopsy risks.

CT-guided FNAB yielded positive results in all patients: lymphoma (3), squamous cell carcinoma (2), metastasis (1), multiple myeloma (1) and xanthogranulomatous inflammation (1). There were no complications in our patient set. Protocols for CT-guided orbital biopsy have been established in a site-specific fashion to optimize patient outcome and limit risk.

In conclusion, CT-guided FNAB of orbital masses is a safe and effective technique for tissue acquisition when utilizing the site-specific guidelines established at our institution. CT-guided FNAB is preferential to surgery in many cases and can be easily established in most interventional radiology departments.

McCrary, B, Mygdal, K, Kerby, T, Eckard, D, Johnson, P, Whittaker, T, Site-Specific Techniques for CT-guided Orbital Biopsy.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4405949.html