Ophthalmology Volume 130, Number 12, December 2023

中文摘要

本研究目的是檢測患有不確定小脈絡膜黑色素病變的患者循環腫瘤細胞（circulating tumor cells, CTCs)的存在。研究對象為47名患有2.5毫米或以下病變厚度和大基底直徑(largest basal diameter)的脈絡膜黑色素病變患者。結果發現CTCs的存在與病變的大基底直徑和厚度呈正相關。儘管觀察和等待可能會導致細胞持續傳播和預後惡化，但由於組織活檢具有很多限制和危險，因此流動生物(liquid biopsy)檢查是解決這些問題的替代方法。然而，目前對於CTCs檢測在不確定小脈絡膜黑色素病變中的敏感性和特異性的確定仍然是一個重要挑戰。因此，流動生物檢查需要進一步在臨床實踐中得到確定。在CTCs陽性患者中，亞視網膜下液(subretinal fluid)、橙色色素(orange pigment)、聲場中空(sonographic hollowness)和大基底直徑大於5毫米的風險因素明顯高於CTCs陰性患者。此外，對不確定小脈絡膜黑色素病變進行組織活檢的敏感性較低，而液體活檢的敏感性和特異性需要進一步研究。

English Abstract

The purpose of this study was to detect circulating tumor cells (CTCs) in patients with small choroidal melanocytic lesions. The study included 47 patients with lesions 2.5 mm or less in tumor thickness. The presence of CTCs was positively associated with both lesion thickness and largest basal diameter. Compared with the nCTC group,a higher percentage of the pCTC group exhibited LBD>5mm (36%vs.88%), subretinal fluid(9.1% vs.56%),orange pigment (4.5%vs.60%), sonographic hollowness (9.1%vs.60%),and the presence of multiple risk factors(0%vs.68% for 3 factors) with P<0.001 for all parameters.The study discusses the challenges in distinguishing between choroidal nevi and early-stage uveal melanoma and the limitations of current diagnostic techniques such as tissue biopsy. Liquid biopsy is proposed as an alternative method, and the study describes the procedure for isolating CTCs from peripheral blood. The sensitivity and specificity of liquid biopsy in detecting tumor cells in uveal melanoma remain important challenges. The study concludes that liquid biopsy has the potential to solve the limitations of current diagnostic techniques but further research is needed.