Using ultrasound to diagnose eye cancer
Prof Mandeep Sagoo | GR001240
2 February 2021
Every year, approximately 1,400 patients are referred to the eye cancer service at Moorfields Eye Hospital. Clinicians then face the challenge of diagnosing the type of tumour, to inform treatment options. In this project, Professor Mandeep Sagoo will test whether modern ultrasound platforms can distinguish between different tumours found inside the eye.
Unlike most other types of cancer, the diagnosis of eye tumours is primarily done by examination and imaging in the clinic. Only in rare circumstances is a biopsy required for tissue diagnosis.
Current imaging techniques can detect and assess harmful intraocular eye cancers, such as choroidal melanoma and secondary deposits, as well as benign tumours, such as choroidal naevi and haemangiomas.
Types of eye cancer
There are several types or ocular cancer:
- Choroidal naevi is a coloured growth at the back of the eye – essentially it is an eye freckle. It usually isn’t harmful but, like a freckle or mole on your skin, it can develop melanoma so your ophthalmologist or optometrist will want to examine it during regular check-ups.
- Haemangiomas are benign lumps caused when a cluster of blood vessels form at the back of the eye. They can distort vision so need to be checked as they might need treatment.
- Uveal melanoma is a rare malignant cancer, affecting just six people per million of the population. It develops from cells in the middle layer of tissue in the wall of the eyeball, called the uvea.
- The uveal tract is made up of the choroid, ciliary body and iris.
- Uveal melanoma can come from any of these components (e.g. choroidal melanoma).
- Depending on the size of the tumour, treatment options include radiation therapy, radiotherapy, photodynamic therapy, or surgery.
- Secondary deposits originate from cancers elsewhere in the body. These are usually a feature of advanced metastatic cancer. It is important to distinguish these from other forms of eye tumour to make sure patients can be offered the correct treatment.
Ultrasound has been widely used for decades in the assessment of ophthalmic disorders, including eye cancers. It is a vital tool in the evaluation of intraocular tumours and is considered the gold standard for clinical diagnosis. Ultrasound can show if the tumour has invaded beyond the eye. Serial scans can also be used to map the growth of a tumour, indicating how aggressive it is.
However, it isn’t known yet how well modern ultrasound with blood flow studies can be used to distinguish between different types of eye tumours.
the proportion of Caucasion people who develop benign choroidal naevi
the number of people who develop choroidal melanoma every year in the UK
Finding a solution
Professor Mandeep Sagoo and his team will use innovative ultrasound platforms to measure blood flow to tumours in the eye. Then, they will test whether it correlates with the different types of intraocular tumour.
The researchers will use‘colour flow mapping’ and‘spectral Doppler’ ultrasound techniques to visualise vessel structures in eye tumours in two dimension. The rate of blood flow will be assessed at the same time. This makes it possible to accurately measure tumour size and tumour vasculature directly in the clinic.
Moorfields Eye Hospital is a unique place to host this study as so many ocular cancer patients are seen there.
This project aims to expand our knowledge of tumour diagnosis using modern ultrasound techniques and help to make the diagnosis less invasive for the patient.
Clinicians hope that this can then be used to inform fast, accurate diagnosis by distinguishing between different types of tumours.
In the long term, the results have the potential to help thousands of future patients in the ocular oncology service.
Research project grant
Prof Mandeep Sagoo