Enhanced Depth Imaging Optical Coherence Tomography: A Primary Modality for Evaluating Nevi Changes
DOI:
https://doi.org/10.48560/rspo.32942Keywords:
Choroid Neoplasms/diagnostic imaging, Nevus, Pigmented / diagnostic imaging, Tomography, Optical Coherence, UltrasonographyAbstract
INTRODUCTION: Our purpose was to analyse the enhanced depth imaging (EDI) - optical coherence tomography (OCT) ability to measure change in thickness and identify high-risk features in choroidal nevi over time.METHODS: Prospective observational study of patients with choroidal nevi in a tertiary hospital. Comprehensive eye examination and multimodal imaging were performed for each nevus, including spectral domain EDI-OCT and B-scan ultrasonography (US) at baseline (0) and one year after (1). Main outcome measures were US and EDI-OCT lesion thickness and change in thickness in micrometre, and nevi features (pigmentation, location of the epicentre, distance to the optic disc margin, shape, largest basal diameter, presence of drusen and orange pigment).
RESULTS: Ninety nevi (86 patients) were included. Three were considered suspicious lesions, one with transformation into melanoma. The median maximum thickness on EDI-OCT at baseline was 581.50 ± 411.75 μm, one year later was 619.50 ± 457.25 μm (p<0.001). The median absolute change in thickness was 28.50 ± 106.50 μm. Sixty-six nevi (73.3%) were never identified on US, behaving as flat. The median maximum thickness on US was 1180.00 ± 660.00 μm at baseline; 1160.00 ± 790.00 μm one year later (p=0.658). The median absolute change in thickness was 195.00 ± 320.00 μm. The US nevi maximum thickness was significantly different from the EDI-OCT in each timing (US-0 1180.00 ± 660.00 μm vs EDI-OCT-0 581.50 ± 411.75 μm, p<0.001; US-1 1160.00 ± 790.00 μm versus EDI-OCT-1 619.50 ± 457.25 μm, p<0.001). The absolute and arithmetic change in thickness significantly differed between US and EDI-OCT (p<0.001 for both). All the 66 consistently flat nevi in US were identified and measured in EDI-OCT (mean thickness 262.58 ± 116.17 μm baseline, 272.29 ± 127.48 μm at one year). Of the 14 lesions with a thickness increase in EDI-OCT of more than 10%, nine (64.2%) were not identified in US.
CONCLUSION: EDI-OCT can consistently measure nevi thickness and its change over time, and identify high-risk features. US failed to identify and measure most nevi, including the ones with significant thickness increase in EDI-OCT. EDI-OCT should replace US in evaluating flat nevi, and might become the primary modality to comprehensively analyse high-risk nevi.
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