Pericardoscopy for primary management of pericardial effusion in cancer patients

• Published in: European journal of cardio-thoracic surgery Vol. 16; no. 3; pp. 287 - 291
• Main Authors: Porte, Henri L., Janecki-Delebecq, Thérèse J., Finzi, Laetitia, Métois, David G., Millaire, Alain, Wurtz, Alain J.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Science B.V 01.09.1999; Elsevier Science
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cardiology. Vascular system; Diseases of the pericardium; Endoscopy - methods; Endoscopy - mortality; Female; Follow-Up Studies; Heart; Humans; Lung cancer; Lung Neoplasms - complications; Lung Neoplasms - diagnosis; Lymphoma, Non-Hodgkin - complications; Lymphoma, Non-Hodgkin - diagnosis; Male; Malignant pericardial effusion; Medical sciences; Middle Aged; Non-Hodgkin lymphoma; Pericardial Effusion - diagnosis; Pericardial Effusion - etiology; Pericardial Effusion - mortality; Pericardial Effusion - surgery; Pericardioscopy; Survival Rate; Treatment Outcome; Non-Hodgkin lymphoma; Pericardioscopy; Lung cancer; Malignant pericardial effusion; Human; Fibroscopy; Pericarditis; Etiology; Heart disease; Pericardial disease; Cardiovascular disease; Endoscopy; Diagnosis; Metastasis; Malignant tumor; Pericardium
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(99)00204-3

Objective: To assess the usefulness of pericardoscopy via the subxyphoid route for the diagnosis and treatment of pericardial effusion in patients with a history of cancer. Methods: All patients with a recent or remote history of cancer and a pericardial effusion of unknown origin requiring drainage for diagnostic and therapeutic purposes were included in the study. They underwent complete exploration and cleansing of the pericardial cavity. Abnormal structures or deposits were biopsied under direct visual control, with a 24 cm long rigid pericardoscope. Results: Between 1985 and 1998, pericardoscopy was completed in 112 of the 114 patients included (feasibility 98 %), resulting in the immediate relief of symptoms in all the cases. Peri-operative mortality was 3.5%, and post-operative morbidity, 6.1%. After pericardioscopy pericardial effusions were considered malignant in 43 cases. One more case (2.3%) due to a false negative result of perycardioscopy was diagnosed during follow-up. Overall, 44 of the 114 patients (38.6%) had a malignant effusion, and 70 (61.4%), a non-malignant effusion according the follow up. In 10 of the 44 patients with a malignant pericardial effusion (22.7%), pericardoscopy corrected the results of cytological pericardial fluid studies and pericardial window biopsy, both false negatives. The sensitivities of cytological studies of the pericardial fluid, pathological examinations of pericardial window biopsy and pericardioscopy were 75, 65 and 97%, respectively. One patient with a malignant effusion had a non-symptomatic recurrence 1 month after pericardioscopy (2.3%). Conclusion: We recommend pericardioscopy to ascertain the malignant nature of the effusion and to diminish the recurrence rate, this avoiding repeat procedures in patients with a short life expectancy.