Purpose: To identify non-overlapping diagnostic features between peripheral exudative hemorrhagic chorioretinopathy (PEHCR) and choroidal melanoma. Methods: A retrospective study of 80 patients (80 eyes); 40 patients (40 eyes) with PEHCR and 40 patients (40 eyes) with choroidal melanoma was conducted. Ophthalmoscopic and imaging features of PEHCR and choroidal melanoma were compared. Sensitivity and specificity for identifying PEHCR and choroidal melanoma were calculated. Youden’s J statistic was assessed for each diagnostic feature. Results: The most frequent clinical features of PEHCR were presence of druse (100%), hemorrhagic PED (93%), dome-shaped mass (B-scan) (90%), and subretinal/intraretinal hemorrhage (78%). Statistical analysis confirmed high sensitivity of hemorrhagic PED (0.93; 95% CI 0.80 – 0.98) and high specificity of clot retraction cleft, presence of lipid exudation and bilaterality (1.00; 95% CI 0.91 – 1.00) as diagnostic features of PEHCR. Statistical analysis revealed presence of subretinal fluid 0.80 (95% CI 0.54 – 0.91) was most sensitive and presence of orange pigment, mushroom shape on B-scan, ciliary body extension, and choroidal excavation were most specific (1.00; 95% CI 0.91 – 1.00) for choroidal melanoma. Non-overlapping diagnostic features of PEHCR were hemorrhagic PED, clot retraction cleft, presence of lipid exudation, and bilaterality. All PEHCR patients (100%) had at least one of these non-overlapping diagnostic features. Non-overlapping diagnostic features of choroidal melanoma were the presence of orange pigment, choroidal excavation, mushroom-shaped mass, and ciliary body extension (the latter 3 detected on B-scan). Youden’s J statistic was highest for hemorrhagic PED and lowest for dome shape appearance on B-scan (0.075). Conclusion: PEHCR and choroidal melanoma can be differentiated by identifying diagnostic features that are exclusive to each entity. The presence of hemorrhagic PED strongly supports a diagnosis of PEHCR. B-scan ultrasonography is required to detect a mushroom-shaped mass, choroidal excavation, or ciliary body extension to exclude underlying choroidal melanoma.


中文翻译：

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周围出血性脉络膜视网膜病变 (PEHCR)：与脉络膜黑色素瘤的鉴别特征

目的：确定外周渗出性出血性脉络膜视网膜病变 (PEHCR) 和脉络膜黑色素瘤之间不重叠的诊断特征。方法：对80例患者（80只眼）进行回顾性研究；对 40 名 PEHCR 患者（40 只眼）和 40 名脉络膜黑色素瘤患者（40 只眼）进行了研究。比较了 PEHCR 和脉络膜黑色素瘤的检眼镜和影像学特征。计算了识别 PEHCR 和脉络膜黑色素瘤的敏感性和特异性。针对每个诊断特征评估 Youden's J 统计量。结果：PEHCR 最常见的临床特征是存在晶簇（100%）、出血性 PED（93%）、圆顶状肿块（B 扫描）（90%）和视网膜下/视网膜内出血（78%）。统计分析证实，出血性 PED 具有高敏感性（0.93；95% CI 0.80 – 0.98），血栓回缩裂、存在脂质渗出和双侧性（1.00；95% CI 0.91 – 1.00）具有高特异性，是 PEHCR 的诊断特征。统计分析显示视网膜下液的存在 0.80 (95% CI 0.54 – 0.91) 最敏感，橙色素的存在、B 扫描蘑菇形状、睫状体延伸和脉络膜凹陷最特异 (1.00; 95% CI 0.91 – 1.00) 用于脉络膜黑色素瘤。PEHCR 的非重叠诊断特征是出血性 PED、凝块回缩裂、存在脂质渗出和双侧性。所有 PEHCR 患者 (100%) 至少具有其中一种不重叠的诊断特征。脉络膜黑色素瘤的非重叠诊断特征是存在橙色色素、脉络膜凹陷、蘑菇状肿块和睫状体延伸（后 3 个在 B 扫描中检测到）。Youden 的 J 统计数据对于出血性 PED 最高，对于 B 扫描上的圆顶形状外观最低 (0.075)。结论：PEHCR 和脉络膜黑色素瘤可以通过识别每个实体独有的诊断特征来区分。出血性 PED 的存在强烈支持 PEHCR 的诊断。需要进行 B 扫描超声检查来检测蘑菇状肿块、脉络膜凹陷或睫状体延伸，以排除潜在的脉络膜黑色素瘤。