Fine Needle Aspiration Biopsy in Orbital Disease

Fine needle aspiration biopsy (FNAB) is a rapid and minimally invasive diagnostic technique and a valid alternative to open biopsies in the evaluation and management of orbital lesions. The use of immunocytochemistry, flow cytometry and molecular genetic workup have markedly improved diagnostic accuracy. With FNAB orbitotomies may be avoided when lesions which can be managed with medical therapies or radiotherapy are proved to be present. FNAB provides considerable advantages as it prevents the need of unnecessary major surgeries by means of a minimally invasive outpatient procedure with rapid recovery. In adults no local or general anaesthesia or sedatives are required. Although a close cooperation between the ophthalmologist/orbitologist, an experienced cytopathologist and sometimes a radiologist (if a computerised tomography guidance is required), is of paramount importance, FNAB is a proven safe procedure when performed by experienced physicians. In masses located at the level of the orbital apex the use of FNAB has its limitations, as it bears the risk of damaging the delicate structures which are hardly packed at this level. For obvious reasons vascular lesions are not suitable for FNABs. Further in optic nerve tumours, chronic inflammations and metastasis by scirrhous tumours the aspirates may be poorly cellular. When a non-diagnostic smear is obtained or when the clinical picture does not meet the results of the cytological findings a re-FNAB or an incisional biopsy for histopathological examination should be performed.