Space-occupying mass lesions in the orbit and peri-orbit are rather uncommon but can be a diagnostic challenge for ophthalmologists and orbital surgeons. In some patients, the combination of clinical presentation and imaging is sufficient to reach a diagnosis; however, many others require morphologic evaluation. The histo-pathologic specification can only be definite by biopsy. The etymologic origin of “biopsy” stems from the Greek words “bios,” meaning “life,” and “opsis,” meaning “sight or view,” together crudely meaning, “to view life.” Plainly, the examination of “live tissue.” Tissue acquisition can be performed via excisional, incisional, core, fine-needle aspiration (FNAB), aspiration-cutter, intraoperative biopsy with frozen-section (FS), or Mohs methods. Occasionally, sentinel node biopsy is utilized for staging purposes of certain orbital tumors.1-3
Most anterior and well-delineated orbital masses can be sampled with any approach: incisional, core, or FNAB. The terms “incisional” and “excisional” are sometimes used interchangeably, but in actuality, “incisional” biopsy refers to cutting into a lesion to sample a portion of tissue solely for the purpose of obtaining a tissue sample, while “excisional” biopsy, implies removal of the tumor and some surrounding normal tissue.1 Naturally, the excised tissue provides more material for histopathologic examination. While incisional biopsy can also obtain a sufficient quantity of tissue for lesions in the anterior orbit, incising tissue acquisition in the posterior orbit can be complex, increasing the risk of complications. In addition, posterior orbital surgery typically requires general anesthesia to facilitate a higher diagnostic yield. Lastly, aspiration is the least invasive technique, and expectedly, offers the least amount of material.4