[Study on the correlation between color Doppler flow imaging and histopathology of choroidal melanoma]

Objective: To explore the correlation between the characteristics of color Doppler flow imaging (CDFI) and histopathological manifestations of choroidal melanoma (CM). Methods: This was a retrospective case series study. The clinical and histopathological data of 49 patients (49 eyes) with CM who underwent enucleation at Tianjin Eye Hospital from February 2004 to March 2022 were collected. All patients underwent CDFI examination and histopathological examination to measure the number of tumor blood vessels. The relationships between the blood flow signals shown by CDFI and the internal blood flow characteristics of the tumor, tumor size, clinical stage, extra-scleral extension grade of the tumor, and cell type were analyzed. The consistency between CDFI and histopathological results was compared using the Adler semi-quantitative method. Paired Wilcoxon signed-rank test and Hodges-Lehman method were used for statistical analysis. Results: Among the 49 CM patients, 28 were male (57.1%) and 21 were female (42.9%). The age was (52.1±11.0) years old, and all cases were unilateral. Regarding the tumor shape detected by CDFI, 26 cases (53.1%) were mushroom-shaped, 11 cases (22.4%) were dome-shaped, and 12 cases (24.5%) were flat and diffuse-shaped. Among the 49 patients, 9 cases (18.4%) had blood flow signal grade Ⅰ, 16 cases (32.7%) had grade Ⅱ, and 24 cases (48.9%) had grade Ⅲ. The location with abundant blood flow inside the tumor was in the superotemporal quadrant in 19 cases (39.6%). The blood flow in the peripheral part of the tumor was more than that in the central part in 34 cases (69.4%). There were 13 large-sized tumors (26.5%), among which 6 cases had grade Ⅰ blood flow signal; 36 medium-sized tumors (73.5%), among which 20 cases (55.6%) had grade Ⅲ blood flow signal. There were 38 cases (77.6%) in the intraocular stage, among which 20 cases (52.6%) had grade Ⅲ blood flow signal; 4 cases in the glaucoma stage, among which 3 cases had grade Ⅰ blood flow signal; 6 cases in the extra-ocular extension stage, among which 4 cases had grade Ⅰ blood flow signal; 1 case in the systemic metastasis stage, showing grade Ⅲ blood flow signal. The extra-scleral extension grade of the tumor was grade Ⅰ (tumor cells involving the sclera) in 31 cases (63.3%), among which 17 cases (54.8%) had grade Ⅲ blood flow signal. There were 32 cases (65.3%) of mixed cell type, among which 17 cases (53.1%) had grade Ⅲ blood flow signal. Histopathological examination showed that the number of blood vessels was 9.0 (6.5, 11.0), the number of blood vessels measured by CDFI was 7.0 (4.0, 9.0), and the difference was 2.0 (1.0, 4.0) [95%CI: 1.5-3.0], and the difference was statistically significant (Z=4.376, P<0.001). The consistency analysis between CDFI and histopathological results showed that the grading was consistent in 40 cases (81.6%) and inconsistent in 8 cases (16.3%). Conclusions: There is a high correlation between the CDFI characteristics of CM patients and histopathological examination, but the former cannot completely replace the latter in measuring the blood vessel situation inside the tumor.