Abstract Purpose: To evaluate the clinicopathological characteristics of biopsied lacrimal drainage system lesions and assess concordance between clinical and histopathological diagnoses. Methods: A retrospective review was conducted of 122 lacrimal drainage system biopsy specimens from 115 patients evaluated at a tertiary referral center. Demographic data, lesion location, clinical impression, and histopathological findings were analyzed. Results: The mean patient age was 60.9 ± 19.1 years, and 65% were female. Most lesions were clinically suspected to be benign (89.3%), most commonly dacryocystitis (40.9%). Thirteen cases (10.6%) were clinically suspicious for malignancy. Histopathological examination confirmed malignancy in three cases (2.4%), including two squamous cell carcinomas and one lymphoma; all had been clinically suspected preoperatively. Overall clinicopathological concordance was 81%. Dacryocystitis demonstrated the highest concordance rate (93%). In contrast, neoplastic lesions showed substantial diagnostic discordance (82%). Chronic inflammation was underrecognized clinically but identified more frequently on histopathology (10.7% vs. 0.8%). Conclusion: Inflammatory lesions, particularly dacryocystitis, represent the predominant pathology of the lacrimal drainage system, especially among older women. Although clinical assessment demonstrates high overall concordance, histopathological evaluation remains essential for excluding malignancy and accurately characterizing lesions with overlapping clinical features.
Barin et al. (2026) studied this question.