Ciliary body and choroidal melanomas are among the few forms of cancer treated before a pathologist assigns a grade to indicate if tumor is likely to follow a benign or aggressive course. The metastatic potential of a ciliary body or choroidal melanoma can be assessed by a pathologist most accurately only after the eye has been removed. Unfortunately, when choosing between enucleation and vision-sparing treatments for these potentially blinding and lethal tumors, ophthalmologists cannot perform conventional biopsies because of the risk to vision, and fine-needle aspiration biopsy does not provide information about the tumor characteristic most strongly associated with metastasis: the architecture of the tumor microcirculation. The long-range objective is to test and refine noninvasive pretreatment strategies that differentiate between patients whose ciliary body and choroidal melanomas are at low versus high risk for metastasis. These strategies are based on (1) the clinical finding that pre-enucleation ultrasound spectrum analysis parameters are strongly associated with histologic microcirculatory patterns and extravascular patterns identified after enucleation and (2) the basic finding that deposits of Type VI collagen and its ligand, hyaluronan, contribute to both vascular and extravascular patterns. Additionally, expression of Type VI collagen and hyaluronan in tumors is associated with properties of invasion and metastasis independent of angiogenesis. The first specific aim tests the hypothesis that extravascular tissue patterns formed by Type VI collagen and hyaluronan, also differentiate histologically between patients at low and high risk for metastasis. The second specific aim tests the hypothesis that clinical ultrasound spectrum analysis reliably classifies choroidal and ciliary body melanomas into their histologic risk groups. It is a prospective clinical study of the diagnostic efficacy of ultrasound spectrum analysis in 100 patients who are scheduled for enucleation for ciliary body or choroidal melanoma. The investigators expect to show that ultrasonographic criteria based on power image spectrum parameters can provide a noninvasive substitute for biopsy.
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