Ultrasonographic and histopathological correlation in choroidal melanoma: survival outcomes from a single-center study in Serbia

To compare ultrasonographic and histopathological measurements of tumor size in enucleated eyes with choroidal melanoma and to evaluate the prognostic significance of tumor dimensions and morphological characteristics in a Serbian cohort. This retrospective study included 59 consecutive patients with histopathologically confirmed choroidal melanoma who underwent enucleation at the University Eye Hospital, Clinical Centre of Serbia. All ultrasonographic examinations, surgical procedures, and histopathological assessments were performed by single dedicated subspecialists. Preoperative B-scan ultrasonography was used to measure tumor base diameter and thickness, which were compared with postoperative macroscopic histopathological dimensions using paired statistical tests, Bland-Altman analysis, and intraclass correlation coefficients (ICC). Survival outcomes were assessed using Pearson and Spearman correlations and Kaplan-Meier analysis. Patients were followed for a minimum of 1 year, with some monitored for up to 5 years. Data are presented as mean ± SD. The mean ultrasonographic base diameter and thickness were 14.63 ± 3.98 and 10.34 ± 3.54 mm, respectively, compared with 18.04 ± 6.54 and 10.55 ± 3.72 mm on pathology. Bland-Altman analysis demonstrated good agreement for tumor thickness (mean difference 0.2 mm; limits of agreement -5.5 to +5.5 mm) and acceptable agreement for base diameter (mean difference 3.4 mm; limits -8.2 to +15.1 mm). ICC indicated moderate agreement for base diameter (0.501) and excellent agreement for thickness (0.843). Pathological thickness correlated significantly with shorter metastasis-free survival (r = -0.293, P = 0.024). Kaplan-Meier analysis showed significantly poorer survival for patients with T3-T4 tumors. Ultrasonography provides a reliable preoperative estimation of choroidal melanoma size, particularly for tumor thickness, although histopathology remains essential for prognostication. Survival patterns in this cohort align with international data, highlighting the relevance of tumor thickness and morphology and emphasizing the value of data from an underrepresented region.