Differentiation of choroidal metastases based on primary cancer site: An imaging study

Abstract: PURPOSE: The objective is to differentiate choroidal metastases (CM) arising from various primary cancer sites based on clinical presentation and imaging. MATERIALS AND METHODS: A retrospective, observational study of 67 eyes (58 patients). RESULTS: The mean age at presentation was 60 years (range, 29–83 years). At presentation, 37 patients (64%) with CM had a known primary systemic cancer, whereas in 21 patients (36%) CM was the first manifestation of systemic cancer. Overall, the primary cancer sites were lung ( n = 32, 55%), breast ( n = 12, 21%), gastrointestinal tract ( n = 6, 10%), genitourinary tract ( n = 3, 5%), and others ( n = 5, 9%). Most choroidal lesions were creamy yellow in color (84%), while 5 eyes (7%) displayed orange-colored lesions secondary to lung neuroendocrine tumors. On multimodal imaging, A-scan showed medium–high internal reflectivity in 35 eyes (69%), and medium–low reflectivity in 16 eyes (31%). Fundus fluorescein angiography (FFA) demonstrated late hypofluorescence in 17 eyes (94%), whereas indocyanine green angiography (ICG) demonstrated hypofluorescence throughout all phases in 11 eyes (69%). Optical coherence tomography (OCT) showed the presence of a lumpy-bumpy choroid with compression of the overlying choriocapillaries ( n = 52, 91%), subretinal fluid ( n = 40, 75%), and hyperreflective foci (HRF) ( n = 25, 47%). Factors such as right eye involvement, orange tumor, the presence of HRF, increased tumor thickness, CM as the first presentation, and a shorter interval between diagnosis of primary cancer and CM were found to be strongly correlated with the origin of primary cancer from the lung compared with breast ( P < 0.05). CONCLUSION: Ancillary imaging along with clinical presentation can provide clues to the origin of CM from various cancer sites, thereby aiding in the early diagnosis, staging, and treatment of primary cancer. CM from lung cancer is more likely to precede the diagnosis of a primary tumor than breast metastases.