Elsevier

Ophthalmology

Volume 116, Issue 8, August 2009, Pages 1558-1563
Ophthalmology

Original article
Lack of Correlation between the Histologic and Magnetic Resonance Imaging Results of Optic Nerve Involvement in Eyes Primarily Enucleated for Retinoblastoma

Accepted for presentation at: American Academy of Ophthalmology Annual Meeting, November 2009, Atlanta, Georgia.
https://doi.org/10.1016/j.ophtha.2009.02.018Get rights and content

Purpose

To correlate the histologic and magnetic resonance imaging results of the optic nerve in eyes primarily enucleated for retinoblastoma.

Design

Retrospective, clinicopathologic correlation.

Participants

Sixty-seven consecutive patients with retinoblastoma who underwent primary enucleation.

Methods

The histologic results of 67 eyes from 67 patients with retinoblastoma who underwent primary enucleation between March 1997 and January 2008 were studied for evidence of optic nerve invasion. Two neuroradiologists independently reviewed available preoperative magnetic resonance imaging studies with special emphasis on nonenhanced T2-weighted and gadolinium-enhanced T1-weighted imaging for evidence of optic nerve invasion. A weighted κ statistic was used to assess agreement between observers.

Main Outcome Measures

Correlation between neuroradiologists and histologic results.

Results

Of the 67 eyes studied, 60 had preoperative magnetic resonance images, 58 of which were deemed appropriate for review by both neuroradiologists. Review of the histologic results showed optic nerve involvement in 62 (93%) of 67 eyes: 28 prelaminar (42%), 24 laminar (36%), and 10 postlaminar (15%). On review of the magnetic resonance scans, the first neuroradiologist identified optic nerve involvement in 57 (95%) of 60 eyes: 26 prelaminar (43%), 10 laminar (17%), and 11 postlaminar (18%). The second neuroradiologist identified optic nerve involvement in 46 (77%) of 60 eyes: 33 prelaminar (55%), 9 laminar (15%), and 4 postlaminar (7%). Moderate agreement existed between neuroradiologists (κ, 0.55). Poor and fair agreement existed between each of the 2 neuroradiologists and histologic results, respectively (κ, 0.29 and 0.17). Exophytic tumors showed the greatest disparity (κ, –0.20 and –0.13) between magnetic resonance imaging and histologic results.

Conclusions

Limited correlation was found between magnetic resonance imaging and histologic results in assessing optic nerve invasion in eyes with retinoblastoma. Magnetic resonance imaging using routine imaging technologies, although useful in the evaluation of retinoblastoma, has limited usefulness in assessing the exact extent of optic nerve invasion; high-risk features of retinoblastoma such as postlaminar invasion remain best defined by histologic analysis. This study demonstrates that the interpretation of optic nerve involvement by a radiologist should not be the determining factor to defer enucleation in favor of neoadjuvant therapy.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Patients and Methods

After obtaining approval from the institutional review board, the Health Insurance Portability and Accountability Act of 1996-compliant database was reviewed to identify those patients with retinoblastoma treated with primary enucleation from March 1997 through January 2008. The following data were retrieved from the patients' medical records: age, gender, laterality of disease, grouping of the affected eye(s), subsequent treatment, and follow-up.

All eyes were enucleated promptly after MRI

Demographics and Histologic Results

We identified 67 eyes (34 right) from 67 patients (34 females, 33 males) that underwent primary enucleation for retinoblastoma between March 2007 and January 2008. Of the 67 patients, 62 had unilateral retinoblastoma. The median age at diagnosis was 2.0 years (range, 1.5 months–15.8 years). All eyes were classified as Reese-Ellsworth group V: 20 were classified as group Va, and 47 were classified as group Vb. Using the International Classification, 49 eyes were classified as group D and 18 as

Discussion

This study found a limited correlation between MRI and histologic results of the optic nerve in eyes with retinoblastoma that were primarily enucleated. Magnetic resonance imaging did not reliably predict prelaminar, laminar, or postlaminar invasion of the optic nerve. Both neuroradiologists had similar κ scores that reflected poor to fair agreement with the histologic results of the optic nerve. The κ score between the neuroradiologists reflected moderate agreement, indicating that, in part,

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    Citation Excerpt :

    MRI is helpful in working through the differential diagnosis, including Coats disease and other inflammatory conditions, as well as persistent fetal vasculature of hyperplastic primary vitreous.44 MRI is not particularly useful in the work-up of microscopic or optic nerve involvement.45–47 Ultrasonography is useful in the diagnosis of retinoblastoma because it can reveal highly reflective calcifications, when present, and it is used during the course of treatment to monitor tumor size with regard to growth or regression.

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Manuscript no. 2008-1255.

Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Supported by Research to Prevent Blindness, Inc, New York, New York; St Giles Foundation, New York, New York.

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