Ocular tumors encompass ocular surface tumors, orbital tumors, and intraocular tumors, characterized by high heterogeneity and complex classifications, which pose considerable challenges to pathological diagnosis. The scarcity of specialized ophthalmic pathologists further exacerbates the difficulty in diagnosing these tumors. In recent years, artificial intelligence (AI) has penetrated diverse areas of healthcare, particularly in departments with intensive medical imaging and image-based workflows, such as radiology, pathology, and ultrasonography. With the advent of the digital pathology era, the role of AI in aiding pathological diagnosis has become increasingly prominent. In recent years, it has been tentatively applied to several ocular tumors, including eyelid sebaceous carcinoma, basal cell carcinoma, malignant melanoma, and orbital lymphoproliferative disorders, exerting an auxiliary diagnostic function. AI can also assist in predicting the prognosis of uveal malignant melanoma and retinoblastoma. In the future, with the increasing popularization and refinement of AI-assisted pathological diagnosis technologies, it will not only enhance the diagnostic accuracy and work efficiency of ocular tumors, better guide clinical treatment, but also alleviate the issues of inadequate medical resources and a shortage of specialized ophthalmic pathologists. 眼部肿瘤包括眼表肿瘤、眼眶肿瘤和眼球内肿瘤，其种类繁多，类型复杂，在病理诊断上具有一定挑战性。而眼科专科病理医生的稀缺，也让眼部肿瘤的诊断更具难度。近年来，人工智能渗入到医疗的各个领域中，特别是医学影像和图像较为集中的科室，如放射、病理和超声等。随着数字化病理时代的到来，人工智能在辅助病理诊断中的作用越来越明显，近年来在眼部的一些肿瘤如眼睑皮脂腺癌，基底细胞癌，恶性黑色素瘤，眼眶淋巴组织增生性病变中都有所尝试应用，起到了辅助诊断的作用。对于葡萄膜恶性黑色素瘤和视网膜母细胞瘤，人工智能也能辅助预测疾病的预后。将来随着人工智能辅助病理诊断的技术不断普及和完善，不仅可以提高眼部肿瘤诊断的准确率和工作效率，更好地指导临床治疗，也解决了医疗资源不足、眼科专科病理医生稀缺的问题。.

To evaluate the prognosis of eyelid sebaceous carcinoma (SeC) in patients with disease stage worse than IIA. This retrospective, single-center study included 78 SeC patients. For stage II patients, 1:3 propensity score matching (PSM) was applied between those undergoing orbital exenteration and those receiving eye-sparing treatments. Risk factors in the eye-sparing group were analyzed using Cox regression, and Kaplan-Meier survival analysis assessed metastasis-free survival (MFS), recurrence-free survival (RFS), disease-specific survival (DSS), and progression-free survival (PFS). Seventy-eight patients treated at Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, from January 2010 to July 2024, were followed for a median of 40.5 months. Of these, 60 patients (76.9%) had stage II disease, 13 patients (16.7%) had stage III, and five patients (6.4%) had stage IV. After PSM, patients with an advanced clinical T (cT) category (cT4 vs. cT3) or equatorial region involvement were more likely to require orbital exenteration and had poorer MFS following eye-sparing surgery. For stage II patients who died of tumor-related causes, the average survival was 144.3 months. For stage III patients with distant metastasis, survival post-metastasis averaged 12.5 months; for stage IV patients, the time from diagnosis to tumor-specific death averaged 49.0 months. In stage II SeC, eye-sparing treatment offered comparable outcomes to orbital exenteration. Orbital exenteration is recommended for tumor involved with the equatorial region. Systemic therapy may be beneficial for patients with distant metastases, although further research is needed to optimize adjuvant treatment.

Sebaceous carcinoma (SC) is a prevalent neoplasm of the eyelid, ranking second to basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in incidence. In some Asian regions, the incidence of SC is as high as 50% with a high risk of invasion and recurrence. Diagnosis of SC is still challenging owing to its atypical histological features and variable immunohistochemical profiles, especially in poorly differentiated ones. Therefore, it is critical to identify more precise immunohistochemical makers for the prediction of SC. In this study, we performed a double-blind, retrospective analysis using tissue microarrays to evaluate the diagnostic accuracy of TRPS1, GATA3, and adipophilin in a cohort with 98 SCs, 56 BCCs, and 55 SCCs. Receiver operating characteristic curves analysis and DeLong's test were used to confirm the applicability of these markers. Binary logistic regression was applied to construct a cancer classification model, with model validity confirmed through likelihood ratio tests (Δ-2LL = 255.937, p < 0.001) and pseudo-R² metrics (Cox & Snell R² = 0.706, Nagelkerke R² = 0.803, McFadden R² = 0.578). Variable contributions were assessed via hierarchical likelihood ratio tests and Wald analyses, revealing significant discriminative power of TRPS1 score (OR = 524.410, p < 0.001) and other predictors. Our results revealed that the combination of above three markers significantly enhanced the diagnostic performance compared to individual ones. Notably, TRPS1 and GATA3 demonstrated superior discriminatory power in distinguishing SC from BCC and SCC to adipophilin. In poorly differentiated SCs, TRPS1 exhibited a markedly higher diagnostic efficacy than GATA3 and adipophilin. In addition, TRPS1 exhibited higher AUC values than GATA3 and adipophilin in differentiating primary and recurrent SCs, although the difference was not significant. Collectively, our findings indicate that the TRPS1/GATA3/adipophilin-based model demonstrated excellent discriminatory efficacy for eyelid malignancies (Kappa = 0.784, micro-average F1 = 0.882, AUC-ROC = 0.964 [95%CI:0.934-0.994]), achieving clinical-grade performance.

Eyelid sebaceous carcinoma (SbC) is a rare malignancy characterized by potentially aggressive behavior and a high local recurrence rate. This study aims to investigate the expression of nuclear YAP and its clinicopathological correlation in eyelid SbC. In the patients with eyelid SbC who had available tumor specimens, nuclear YAP and androgen receptor (AR) expression were assessed using immunohistochemistry staining, quantified by histochemical scoring (H-score). The primary outcome was local recurrence-free survival (LRFS). Additionally, distant recurrence-free survival, recurrence-free survival, and overall survival were evaluated. Among 47 patients, local recurrence occurred in 10 cases (21.3%), and distant recurrence was observed in 4 cases (8.5%) over a median follow-up period of 39.5 months. All local recurrence events were observed in the low nuclear YAP group (H-score ≤ 90), with a 5-year LRFS of 66.2% among 36 patients. Additionally, lower AR expression (H-score ≤ 50) was linked to a decreased 5-year LRFS of 59.4%, compared to 82.6% in the high AR expression group (Hazard ratio, 3.43; 95% CI, 0.96-12.20; p = 0.043). Lower nuclear YAP and AR expression appear to be associated with high local recurrence rates. Nuclear YAP expression may serve as a promising biomarker for prognosticating local recurrence in eyelid SbC.

Regional lymph node metastasis is the primary cause of disease progression in patients with eyelid sebaceous carcinoma (SC). This study aims to investigate the diagnostic accuracy of palpation and ultrasonography for detecting lymph node metastasis, as well as to identify risk factors associated with occult lymph node metastasis. This diagnostic study was conducted using a retrospective cohort of 102 patients with 120 eyelid SC tumours. All patients with eyelid SC who underwent clinical palpation and ultrasonographic imaging of regional lymph nodes at Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, between 1 January 2015 and 31 December 2024, were included. Among the 102 patients with 120 eyelid SC tumours, 33 tumours were pathologically confirmed to have lymph node metastasis. Clinical palpation demonstrated a sensitivity of 66.7% and specificity of 96.6%, while ultrasonography showed a sensitivity of 87.9% and specificity of 97.7%. The combination of ultrasonography and palpation increased the sensitivity to 93.9%, with specificity remaining high at 95.4%. In patients with negative palpation results, comparison of clinicopathological characteristics between metastatic and non-metastatic tumours revealed significant differences in American Joint Committee on Cancer (AJCC) T stage (p=0.001), tumour differentiation (p=0.046) and lymphovascular invasion (p=0.001). We found that the combination of ultrasonography and palpation is an effective initial screening method, with a sensitivity of 93.9% and a specificity of 95.4%. Patients with advanced AJCC T stage, poor tumour differentiation or presence of lymphovascular invasion are more likely to present with palpation-negative lymph node metastasis.