Background

Accurate pre-operative diagnosis of orbital lesions supports appropriate prioritisation of patients into available theatre time. We examine the accuracy of pre-operative clinico-radiological diagnosis in a tertiary centre with weekly dedicated orbital clinics and associated multi-disciplinary team meetings.

Methods

A retrospective case notes review was undertaken for all patients who had an orbital biopsy performed at Bristol Eye Hospital between 2007 and 2017. In this centre, pre-operative clinico-radiological differential diagnoses are discussed during multi-disciplinary team meetings including two orbital specialist ophthalmologists and a specialist neuro-radiologist. Clinico-radiological diagnoses were compared with histopathological outcomes. Subcategory analysis according to histopathological diagnosis was undertaken to look for trends.

Results

172 biopsies were taken from 156 patients, median age 59 years (range 3 months to 91 years). 60.9% of patient were females, with equal numbers of right and left-sided biopsies. 11 patients had inconclusive histopathology. 15 patients did not have a documented preoperative diagnosis or differential offered in available notes. 71 patients (49.0%) demonstrated an exact match between clinico-radiological and histopathological diagnosis, 93 (64.1%) demonstrated a category match (e.g. inflammatory, lymphoproliferative) and for 111 (76.6%), the histopathological diagnosis was considered within the list of proffered clinico-radiological differential diagnoses.

Conclusions

Accuracy of pre-operative diagnosis of orbital lesions undergoing biopsy was higher in our series than previously reported by Koukoulli et al. Specialist head and neck radiology input via regular orbital multi-disciplinary meetings might be reciprocally educational and explain this difference. The authors recommend all surgeons who perform orbital surgery should have access to such multi-disciplinary meetings.

中文翻译：

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与专业放射科医生举行的多学科团队会议可以提高需要眼眶活检的患者的术前临床放射诊断准确性，并提供互惠教育机会

背景

眼眶病变的准确术前诊断支持对患者进行适当的优先排序，使其进入可用的手术室时间。我们在三级中心检查术前临床放射诊断的准确性，该中心每周举行专门的眼眶诊所和相关的多学科团队会议。

方法

对 2007 年至 2017 年间在布里斯托尔眼科医院进行眼眶活检的所有患者进行了回顾性病例记录审查。在该中心，包括两名眼眶专科眼科医生在内的多学科团队会议期间讨论了术前临床放射学鉴别诊断和一名专业神经放射科医生。将临床放射学诊断与组织病理学结果进行比较。根据组织病理学诊断进行亚类分析以寻找趋势。

结果

对 156 名患者进行了 172 份活检，中位年龄 59 岁（范围从 3 个月到 91 岁）。60.9% 的患者为女性，右侧和左侧活检数量相同。11名患者的组织病理学结果不确定。15 名患者没有记录在案的术前诊断或可用笔记中提供的鉴别诊断。71 名患者 (49.0%) 表现出临床放射学和组织病理学诊断之间完全匹配，93 名患者 (64.1%) 表现出类别匹配（例如炎症、淋巴增殖性），111 名患者 (76.6%) 的组织病理学诊断被认为在以下列表中：提供临床放射学鉴别诊断。

结论

在我们的系列中，接受活检的眼眶病变的术前诊断准确性高于 Koukoulli 等人之前报道的。通过定期的轨道多学科会议，专家头颈放射学的输入可能是相互教育的，并解释了这种差异。作者建议所有进行眼眶手术的外科医生都应该有机会参加此类多学科会议。