Original Investigation | Clinical Sciences

Autofluorescence Quantification of Benign and Malignant Choroidal Nevomelanocytic Tumors

Daniel L. Albertus, MD1; Ira H. Schachar, MD, MSc1; Sarwar Zahid, MD, MS1; Victor M. Elner, MD, PhD1; Hakan Demirci, MD1; Thiran Jayasundera, MD1
[+] Author Affiliations
1Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor
JAMA Ophthalmol. 2013;131(8):1004-1008. doi:10.1001/jamaophthalmol.2013.4007.
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Importance  Accurate diagnosis of choroidal melanoma is challenging and has important implications for both physicians and patients. We assessed the utility of quantification of fundus autofluorescence in the evaluation and follow-up of choroidal nevomelanocytic tumors.

Objective  To assess the utility of autofluorescence quantification in distinguishing clinically diagnosed choroidal nevi, melanoma, and indeterminate nevomelanocytic lesions.

Design, Setting, and Participants  A retrospective observational study from 2006 to 2012 of patients with choroidal nevomelanocytic lesions who had digital autofluorescence and color fundus imaging performed at the University of Michigan Kellogg Eye Center.

Intervention  ImageJ software was used to output autofluorescence gray-scale values for each pixel of a 500 × 50-pixel region within each lesion and a corresponding adjacent control region.

Main Outcome and Measure  A single value was generated, termed the Index of Retinal Autofluorescence (IRA), to represent the total difference in gray-scale values between the 2 regions in each affected eye.

Results  Thirteen of the 14 clinically diagnosed nevi exhibited an IRA less than 150 gray-scale intensity squared (gsi2). Eight of 9 clinically diagnosed melanomas exhibited an IRA more than 150 gsi2. An IRA of 150 gsi2 distinguished nevi from melanomas with a sensitivity of 0.89 and specificity of 0.93. Fifteen of 19 patients with indeterminate nevomelanocytic lesions underwent clinical assessment and initial imaging with clinical follow-up at a median of 10 months. All 3 patients with an IRA less than 150 gsi2 showed no evidence of clinical progression and 6 of 12 lesions with an IRA more than 150 gsi2 showed clinical progression to melanoma. An IRA of 150 gsi2 identifies indeterminate lesions that progressed to melanoma with a sensitivity of 1.00 and specificity of 0.33.

Conclusions and Relevance  Quantification of digital autofluorescence images can differentiate between clinically benign and malignant choroidal nevomelanocytic lesions and may be predictive for clinical progression of indeterminate lesions.

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Figure 1.
Index of Retinal Autofluorescence Determination From Autofluorescence Images of Melanoma and Nevus

A, Color fundus photograph of melanoma in patient 907. B, Corresponding autofluorescence photograph of tumor. C, Color fundus photograph of nevus in patient 524. D, Corresponding autofluorescence photograph of tumor. The 500 × 50-pixel areas were selected for each tumor (rectangle) and compared with a similar-sized adjacent fundus region (not shown) to derive Index of Retinal Autofluorescence values.

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Figure 2.
Autofluorescence Signatures From Tumors and Adjacent Regions Used to Derive the Index of Retinal Autofluorescence

Each autofluorescence signature represents vertically averaged gray-scale values at each of the 500 pixels along the horizontal axis. A, Comparison of melanoma autofluorescence signature and adjacent fundus region yielded an Index of Retinal Autofluorescence of 324 gray-scale intensity squared (gsi2). B, Comparison of nevus autofluorescence signature and adjacent fundus region yielded an Index of Retinal Autofluorescence of 45 gsi2.

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