This is a retrospective review of 119 patients diagnosed with ocular adnexal lymphoma, 85 of whom had primary adnexal disease and 34 had previously been diagnosed with lymphoma outside the ocular adnexa. Sixty-eight of the primary and 24 of the secondary patients underwent positron emission tomography (PET) scanning, and 42 and 19 of these were positive respectively. However, a significant proportion were only positive in the adnexal region. Excluding these, 24 (35%) of the primary and 13 (54%) of the secondary had positive PET scans. As would be expected positive PET scanning was more likely to be found in higher grade tumours. One hundred and twelve patients underwent bone marrow biopsy, 80 with primary adnexal lymphoma and 32 with secondary disease. Of these, nine and seven respectively were positive, with no difference in positive biopsy rates comparing high grade with low grade lymphomas. Thirty-eight of the 85 patients with primary adnexal lymphoma underwent gastrointestinal endoscopy, with only one having positive findings. The authors conclude that a substantial proportion of both primary and secondary adnexal lymphoma patients have positive PET scans, or bone marrow biopsies. Unfortunately there is no information on how patients were selected for these investigations from the total number of 119. It is possible there was some selection bias, with patients at greater risk of higher stage disease being more likely to undergo further investigation. It is revealing that half the patients had negative ocular PET scans, given they were all scanned prior to any treatment. Despite these drawbacks the paper provides useful evidence that PET scanning may provide more accurate staging in adnexal lymphoma, especially for higher grade tumours.

Rates of positive findings on positron emission tomography and bone marrow biopsy in patients with ocular adnexal lymphoma.
Thuro BA, Ning J, Peng SA, et al.
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James Hsuan

Aintree University Hospital, Liverpool, UK.

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