@article{discovery1547029,
            year = {2017},
          number = {6},
           month = {June},
         journal = {Ophthalmology},
            note = {Copyright {\copyright} 2017 by the American Academy of Ophthalmology. Published by Elsevier Inc. This manuscript version is made available under the CC-BY-NC-ND 4.0 license (http://creativecommons.org/licenses/by-nc-nd/4.0/)},
           pages = {851--858},
           title = {High-Risk Histopathology Features in Primary and Secondary Enucleated International Intraocular Retinoblastoma Classification Group D Eyes},
          volume = {124},
          author = {Fabian, ID and Stacey, AW and Chowdhury, T and Duncan, C and Karaa, EK and Scheimberg, I and Reddy, MA and Sagoo, MS},
            issn = {1549-4713},
             url = {http://dx.doi.org/10.1016/j.ophtha.2017.01.048},
        abstract = {PURPOSE: To evaluate the rate and identify the risk factors for high-risk histopathologic features in group D retinoblastoma eyes enucleated as primary or secondary treatment. DESIGN: Retrospective analysis. PARTICIPANTS: A total of 64 enucleated group D eyes (62 patients), of which 40 (40 patients) were primary and 24 (22 patients) were secondary to other treatments. METHODS: Clinicopathologic correlation of consecutive group D eyes enucleated from 2002 to 2014. High-risk histopathologic features were defined as the presence of anterior chamber seeds, iris infiltration, ciliary body/muscle infiltration, massive ({$\ge$}3 mm) choroidal invasion, retrolaminar optic nerve invasion, or combined non-massive choroidal and prelaminar/laminar optic nerve invasion. MAIN OUTCOME MEASURES: High-risk histopathologic features, metastasis, and death. RESULTS: Of the 64 group D eyes, 37 (58\%) were classified as cT2bN0M0H0, 24 (38\%) were classified as cT2bN0M0H1, and 3 (5\%) were classified as cT2aN0M0H1, according to the 8th edition cTNMH Retinoblastoma Staging. High-risk histopathologic features were detected in 10 eyes (16\%) in the entire cohort, 5 eyes (13\%) of the primary enucleated group (pT3aNxM0, n�= 2 and pT3bNxM0, n�= 3, 8th edition pTNM), and 5 eyes (21\%) of the secondary enucleated group (pT2bNxM0, n�= 2, pT3aNxM0, n�= 2 and pT3cNxM0, n�= 1). Absence of�vitreous seeds at presentation was the only predictive factor found for high-risk histopathologic features in the primary enucleation group (P�= 0.042), whereas none were found in the secondary group (P {$\ge$} 0.179). Invasion of the anterior structures (anterior chamber, iris, ciliary body/muscle) was detected significantly more after secondary enucleation (P�= 0.048). All patients with high-risk histopathologic features were treated with adjuvant chemotherapy, and no metastases were recorded in a median follow-up time of 73.2 months (mean, 71.5; range,�13.7-153.0). CONCLUSIONS: The choice of primary treatment for group D retinoblastoma should be carefully weighed, because according to this study, 13\% of eyes harbor high-risk histopathologic features at presentation, with the absence of vitreous seeds being a potential risk factor. It is of special importance in group D eyes being considered for nonsystemic treatment, such as primary intraophthalmic artery chemotherapy. Secondary enucleated group D eyes with high-risk histopathologic features more commonly involved anterior structures, warranting meticulous clinical and histologic examinations for this subset of patients.}
}