Shields et al identified risk factors that could be used to predict whether a small choroidal melanocytic tumor was likely to grow in size. This can be used to help counsel patients with these lesions when discussing treatment options. The authors are from the Wills Eye Hospital in Philadelphia, Pennsylvania.
Parameters:
(1) tumor thickness
(2) extent of posterior tumor margin
(3) visual symptoms
(4) orange pigmentation
(5) subretinal fluid
|
Parameter |
Finding |
Points |
|
tumor thickness in mm |
<= 2 mm |
0 |
|
|
> 2 mm |
1 |
|
extent of posterior tumor margin |
not touching optic disc |
0 |
|
|
touching optic disc |
1 |
|
visual symptoms |
absent |
0 |
|
|
present |
1 |
|
orange pigmentation |
absent |
0 |
|
|
present |
1 |
|
subretinal fluid |
absent |
0 |
|
|
present |
1 |
number of risk factors =
= SUM(points for the parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 5
• The risk of growth increases as the number of risk factors increase.
• For 1 to 4 risk factors, the risk of growth varies with the mix of factors, as shown in the table on page 362. The combination with the greatest percentage showing growth (69%) was thickness > 2 mm, posterior margin touching the optic disc and the presence of subretinal fluid.
|
Number of Risk Factors Present |
Relative Risk of Growth |
Kaplan-Meier 5 Year Growth |
|
0 |
1 |
3% |
|
1 |
1.9 |
33-44% |
|
2 |
2.8 |
38-68% |
|
3 |
7.4 |
40-69% |
|
4 |
14.1 |
42-64% |
|
5 |
27.1 |
56% |
where:
• The calculation of relative risk assumes independence between the factors, which may not be the case (page 362).
Specialty: Hematology Oncology, Surgery, general, Ophthalmology
