Supplementary Material for: Novel Guarded Needle Trans-Scleral Biopsy for Uveal Melanoma: A Pilot Study

<b><i>Introduction:</i></b> Trans-scleral biopsy of uveal melanoma (UM) poses an inherent risk of tumor and possibly retinal perforation. We describe a novel technique for trans-scleral biopsy of UM and evaluate its safety and efficacy in an initial cohort of patients. <b><i>Methods:</i></b> A retrospective, consecutive observational case series was conducted from October 14, 2019, to April 15, 2020, at Kaiser Permanente, San Francisco, CA among patients with UM of the ciliary body or anterior choroid undergoing trans-scleral fine-needle aspiration biopsy using a novel guarded needle technique. <b><i>Results:</i></b> A total of 6 patients were included in the study, with a mean age of 64.3 (range 35–77) years (5 women 83%). Mean (±SD) tumor thickness and maximal basal diameter were 6.4 (±2.66) and 11.9 (±2.13) mm, respectively. Five out of 6 patients achieved a successful biopsy with reliable gene expression profiling (GEP) results. The only failure to obtain specimen occurred in the first attempted patient and, after a minor technique modification, all subsequent biopsies were successful. No intraoperative or short-term postoperative complications were observed in any patient. <b><i>Conclusion:</i></b> This novel trans-scleral biopsy technique appears to be safe and effective when obtaining UM tissue for GEP. This method may provide a more controlled biopsy depth thereby minimizing the risk of tumor perforation and its associated complications while still obtaining adequate biopsy yield.

<b><i>引言:</i></b> 脉络膜黑色素瘤（uveal melanoma, UM）的经巩膜活检存在肿瘤乃至视网膜穿孔的固有风险。本研究介绍一种用于UM经巩膜活检的新技术，并在初始患者队列中评估其安全性与有效性。<b><i>方法:</i></b> 本研究为回顾性连续观察病例系列，于2019年10月14日至2020年4月15日期间，在加州旧金山凯撒永久医疗（Kaiser Permanente）开展，纳入接受新型防护针技术行经巩膜细针抽吸活检的睫状体或前脉络膜UM患者。<b><i>结果:</i></b> 本研究共纳入6例患者，平均年龄为64.3岁（范围35~77岁），其中女性5例，占比83%。患者的平均肿瘤厚度（±标准差）为6.4±2.66 mm，平均最大基底直径为11.9±2.13 mm。6例患者中5例活检成功，并获得可靠的基因表达谱（gene expression profiling, GEP）检测结果。仅首例尝试活检的患者未获取到样本，经小幅技术调整后，后续所有活检均获得成功。所有患者均未出现术中或短期术后并发症。<b><i>结论:</i></b> 该新型经巩膜活检技术在获取UM组织用于GEP检测时，表现出良好的安全性与有效性。该方法可实现更精准的活检深度控制，从而降低肿瘤穿孔及其相关并发症的风险，同时仍可获取足够的活检样本量。