Nondiagnostic conjunctival map biopsies for sebaceous carcinoma

Area of Science:

• Ophthalmology
• Oncology
• Pathology

Background:

• Sebaceous carcinoma is a rare malignancy of the ocular surface.
• Pagetoid spread of sebaceous carcinoma can involve extensive areas of the ocular surface.
• Accurate diagnosis relies on representative biopsies, but artifactual changes can hinder interpretation.

Purpose of the Study:

• To compare the rate of nondiagnostic conjunctival map biopsies between patients with extensive pagetoid sebaceous carcinoma and those with limited or no pagetoid involvement.
• To investigate the association between tumor extent and biopsy quality.

Main Methods:

• Retrospective review of medical records and 20 patients' conjunctival map biopsies for sebaceous carcinoma.
• Biopsies were classified as nondiagnostic if they showed artifactual epithelial loss or damage.
• Patients were stratified based on tumor extent: extensive (3-4 quadrants) vs. limited (1-2 quadrants).

Main Results:

• Overall, 15% of 144 reviewed biopsies were nondiagnostic.
• Nondiagnostic biopsies were significantly more common in patients with extensive pagetoid tumor (57%) compared to those without (22%).
• The odds ratio for a nondiagnostic biopsy in extensive disease was 5.9 (P = .004).

Conclusions:

• Conjunctival map biopsies with artifactual de-epithelialization are more prevalent in extensive pagetoid sebaceous carcinoma.
• Infiltrating tumor cells may disrupt epithelial adhesion, leading to nondiagnostic specimens.
• This highlights potential challenges in diagnosing extensive ocular surface malignancies.