The role of fine needle aspiration cytology in the diagnosis of orbital lesions

Context: Fine needle aspiration cytology (FNAC) in orbital lesions has gained importance over the last 3 decades, especially with the advent of imaging studies. Aims: The study was undertaken to evaluate the role of FNAC as a diagnostic tool in patients presenting with orbital mass lesions. Subjects and Methods: Patients of different age groups presenting with orbital lesions were studied over a period of 2 years. The 38 patients selected for this study were evaluated clinically by thorough general and ophthalmological examination, and then were investigated with computed tomography (CT) scanning (both axial and coronal planes). Each patient included in this study was then subjected to FNAC under direct vision or under ultrasonography or CT guidance with a sterile 22 gauge needle without anesthesia. Results: The age of the patients varied from 2 to 72 years. On cytology, four cases were diagnosed as nonneoplastic and the remaining 34 (89.48%) as neoplastic lesions. In the neoplastic group, benign tumors (20; 58.8%) outnumbered malignant (14; 41.2%). The distribution of malignant lesions was more heterogeneous with a predominance of lymphoma involving the orbit. Surgical biopsy was done in 27 cases. Surgical biopsy report correlated with the FNAC report in 23 out of 27 cases. The sensitivity was 86.6%, specificity 100%, and positive predictive value 100%. Conclusion: FNAC is a useful, safe and cost-effective method of diagnosing orbital pathology. Image guidance is helpful especially in deeply situated nonpalpable lesions.