The role of endomyocardial biopsy in cardiac tumors diagnosis.

Abstract

e22536 Background: Pathologic examination is essential for definite diagnosis of both primary and secondary (metastatic) cardiac tumors. Limited data exists on the risks and benefits of catheterization with endomyocardial biopsy (EMB) of cardiac tumors. The present study aims to assess the safety of EBM in diagnosing cardiac tumors. Methods: We retrospectively reviewed therecords of cancer patients who presented with cardiac masses at MD Anderson Cancer Center between 2011 and 2016. Clinical presentation, transthoracic/transesophageal echocardiogram and pathology laboratory results for patients who underwent cardiac catheterization & EMB were reviewed. Results: Out of 8 patients with cardiac tumors (4 females, 4 men, average age of 59.7 y.o.), 5 patients had cardiac catheterization with EMB (5.4 French with Jaw Volume of 2.2, specimens are typically 5 to 20 mg per sample). Clinical presentation included shortness of breath and dyspnea (3 patients), syncope and palpitations (1 patient), and fatigue and slurred speech, as result of a hemispheric stroke (1 patient). Diameter of the cardiac tumors ranged between 4 – 6.5 cm, with no wall abnormalities or hemodynamic compromise as identified by echocardiography. Right atrium (RA) was the most common location (4 patients). One patient had extension of bronchus squamous cell tumor extending into a coronary artery bypass graft (LIMA). Review of the pathological specimens obtained from EMB performed under TEE and fluoroscopic guidance identified 2 patients with cardiac sarcomas in the RA, 1 patient with atrial metastatic melanoma (RA) and 1 patient with lymphoma (right ventricle). EMB was performed with minimal blood loss in all patients. During procedure, one patient developed rapid accumulation of fluid in the pericardial space requiring emergent echo-guided pericardiocentesis. Conclusions: EMB is suggested for the diagnosis of selected cardiac tumors, if the potential benefits from the procedure outweighs the risks. A more invasive approach for rapid histological diagnosis allows appropriate therapy to be promptly initiated. To ensure the safety, EMB should be performed by an experienced operator with fluoroscopy and with transthoracic, transesophageal or intra-cardiac echocardiography guidance.