Diagnostic methods for primary vitreoretinal lymphoma: A systematic review.

Area of Science:

• Ophthalmology
• Oncology
• Medical Diagnostics

Background:

• Primary vitreoretinal lymphoma (PVRL) is an intraocular malignancy that can be misdiagnosed as chronic uveitis, leading to diagnostic delays.
• Accurate and timely diagnosis of PVRL is crucial for effective treatment and improved patient prognosis.
• The optimal diagnostic modality for PVRL remains unclear despite various available techniques.

Approach:

• A systematic literature search was conducted across Ovid MEDLINE, EMBASE, and the Cochrane Controlled Register of Trials for studies published between January 2000 and June 2023.
• Included studies focused on randomized controlled trials (RCTs) evaluating diagnostic tools for PVRL, such as cytology, flow cytometry, MYD88 L265P and CD79B mutation analysis, IL-10/IL-6 ratio, PCR for IgH/IgK rearrangements, and imaging.
• The aggregated sensitivity of each diagnostic modality was calculated and compared using the chi-squared test.

Key Points:

• The interleukin-10/interleukin-6 (IL-10/IL-6) ratio demonstrated the highest sensitivity (89.39%) for diagnosing PVRL.
• Flow cytometry of vitreous samples (88.00%) and PCR for monoclonal IgH rearrangements (85.10%) also showed high sensitivity.
• MYD88 L265P (70.00%) and CD79B mutation analysis (35.09%) exhibited lower sensitivity in PVRL diagnosis.

Conclusions:

• An IL-10/IL-6 ratio greater than or equal to one appears to be the most sensitive diagnostic marker for PVRL.
• While vitreous and aqueous samples showed similar sensitivity for the IL-10/IL-6 ratio, further studies are needed.
• Future research should focus on combining multiple diagnostic tools to enhance PVRL detection and establish definitive diagnostic guidelines.