Diagnostic Value of Pericardial Biopsy

Abstract

Background— The clinical significance of pericardial biopsy is controversial. The aim of this study was to assess the feasibility and diagnostic value of 3 approaches to pericardial biopsy: fluoroscopic control and standard sampling, pericardioscopy guidance with standard sampling, and pericardioscopy guidance with extensive sampling. Methods and Results— Forty-nine subsequent patients with a large pericardial effusion underwent parietal pericardial biopsy. In group 1 (12 patients, 66.7% males, age 46.7±12.2 years), pericardial biopsy was guided by fluoroscopy (3 to 6 samples per patient). Group 2 included 22 patients (50% males, age 50.8±10.4 years) undergoing 4 to 6 pericardial biopsies per patient guided by pericardioscopy (16F flexible endoscope). In group 3, extensive pericardial sampling was performed, guided by pericardioscopy (15 patients, 53.3% males, age 53.7±12.8 years, 18 to 20 samples per patient). Sampling efficiency was better with pericardioscopy (group 2, 84.9%; group 3, 84.2%) compared with fluoroscopic guidance (group 1, 43.7%; P <0.01). Diagnostic value was defined as a new diagnosis uncovered, etiology revealed, clinical diagnosis confirmed, and the biopsy false-negative. Pericardial biopsy in group 3 had higher diagnostic value than in group 1 in revealing new diagnosis (40% versus 8.3%, P <0.05) and etiology (53.3% versus 8.3%, P <0.05). In group 2, pericardial biopsy had a higher yield in establishing etiology than in group 1 (40.9% versus 8.3%; P <0.05). Pericardial biopsy was false-negative in 58.3% in group 1 in contrast to 6.7% in group 3 ( P <0.01). There were no major complications. Conclusions— Pericardioscopic guidance enhanced pericardial sampling efficiency. The diagnostic value of pericardial biopsy was significantly improved by extensive sampling made possible by pericardioscopy.

CT Findings in Patients With Pericardial Effusion: Differentiation of Malignant and Benign Disease

“…The sensitivities of cytologic examination of pericardial fluid and pericardial biopsy for malignant pericardial effusion are approximately 75-87% and 27-76%, respectively [26]. Pericardial biopsy guided by pericardioscopy has a sensitivity of 93.3-97% [3,27]. Even though abnormal (smooth or irregular) pericardial thickening was a significant finding of malignant pericardial effusion, the sensitivity, spec- [26], the reference standard for malignant pericardial effusion might have been controversial in cases in which pericardial effusion in patients with malignant disease (n = 43) was proved benign (n = 14) with the initial negative cytologic finding (n = 11) or after tissue biopsy (n = 3) with more than 1 year of clinical and radiologic follow-up.…”

Tuberculous pericarditis: Challenges and controversies in the modern era

“…Percutaneous pericardioscopy is a minimally invasive technique with a low complication rate for obtaining pericardial tissue, allowing for a more detailed evaluation of the diseased pericardium than evaluation of fluid specimens alone. (24) Through the introduction of a flexible fibre-optic scope into the pericardial space, both the epicardium and parietal pericardium can be assessed for areas of inflammation, allowing targeted biopsies to be acquired under direct vision ( Figure 1). It has been demonstrated to have a low risk profile in large series, with not a single reported mortality attributable to the procedure.…”

“…It has been demonstrated to have a low risk profile in large series, with not a single reported mortality attributable to the procedure. (24)(25)(26)(27)(28) The risk of the procedure is the inherent risk associated with the pericardiocentesis procedure itself, and not pericardioscopy. In the Marburg registry, including 259 patients, pericardial biopsy by this technique allowed for a more definitive aetiological classification and targeted therapy in patients presenting with pericardial effusion in a first world setting.…”

“…It has also been proven that extensive sampling (18 -20 biopsies) improves the diagnostic yield of the procedure, whilst not impacting on procedural safety as compared to limited sampling of 4 -6 biopsies. (24) The probability of diagnosing an infiltrate is also significantly higher in epicardial than in parietal pericardial sampling (80% vs. 7% in neoplastic disease, and 93% vs. 14%…”

Pericardial diseases in the era of imaging, biomarkers and molecular diagnosis

“…But it does not treat the cause of it. Entering the pericardium and sampling pericardial [20] and epicardial tissue under the control of a fiberglass endoscope, the pericardioscope, will permit further investigations. Pericardioscopy allows safe biopsies under optical control and has opened a new window to the heart [21,22] as illustrated by convincing images and the contribution by Maisch and coworkers in the issue.…”