Diagnostic Utility of Fine Needle Aspiration Cytology of the Orbit: A 26 Year Retrospective Study of a Single Institution’s Experience

Objectives: Diagnosing orbital tumors is challenging due to the intricate anatomy of the orbit and associated risks of surgical biopsy. Fine needle aspiration (FNA) of the orbit provides a less invasive alternative to surgical biopsy. Study Design: The surgical pathology database was retrospectively searched and analyzed for orbital specimens obtained by fine needle aspiration at Wake Forest Baptist Medical Center between the years 1990 and 2016. Results: Of the 62 specimens from 61 patients, 38 cases (38/62, 61.3%) were malignant neoplasms, 9 cases (9/62, 14.5%) were benign lesions, and 15 cases (15/62, 24.2%) were unsatisfactory/non-diagnostic. The most common neoplastic diagnosis was hemato/lympho-proliferative processes (33/38, 86.8% of the malignant neoplastic lesions), predominantly non-Hodgkin’s lymphoma (NHL) (29/38, 76.3% of the malignant neoplastic lesions). 19 NHL cases (65.5% of NHL cases) had been confirmed by subsequent flow cytometric analysis. FNA results from 12 cases had been compared with surgical biopsy diagnosis. The diagnostic accuracy was 11/12 or 91.7%. Conclusions: FNA of the orbit is a relatively non-invasive and cost-effective method in diagnosing orbital tumors; it is especially valuable in identifying hematolymphoid malignancies in the orbit, mainly non-Hodgkin’s lymphoma.