Evaluation of imaging techniques for detection of extraocular extension of choroidal melanoma.

OBJECTIVE To investigate the sensitivity of echography vs magnetic resonance imaging (MRI) or computed tomography (CT) for detecting extraocular extension of choroidal malignant melanoma. DESIGN AND SETTING Retrospective review at a university referral center. PARTICIPANTS All patients with histopathologically proven extraocular extension of choroidal malignant melanoma evaluated at the Bascom Palmer Eye Institute, Miami, Fla, between January 1, 1988, and August 31, 1997. INTERVENTIONS The histopathology records of all patients who underwent enucleation for choroidal malignant melanoma or biopsy of an extraocular nodule during the study period were reviewed. The records and imaging studies of patients who were found to have extraocular extension of choroidal malignant melanoma were then reviewed to determine the sensitivity of preoperative echography vs MRI or CT for detecting extraocular tumor extension. RESULTS A review of 297 histopathology records identified 13 patients with extraocular extension of choroidal malignant melanoma. Three patients with only microscopic extraocular tumor extension were excluded from the study. Of the remaining 10 patients, all underwent ocular echography preoperatively, 5 underwent orbital MRI, and 2 underwent orbital CT scanning to evaluate for extraocular extension of tumor. Extraocular tumor extension was demonstrated in 10 patients (100%) with echography and in 2 (29%) of 7 patients with MRI (2 of 5 patients) or CT (0 of 2 patients). In no instance did MRI or CT demonstrate extraocular tumor extension that was not identified with echography. CONCLUSION At this institute, ocular echography is more sensitive than MRI or CT for the detection of extraocular extension of choroidal malignant melanoma.