Pericardiocentesis versus Pericardiotomy for Malignant Pericardial Effusion: A Retrospective Comparison

Labbé, Catherine; Tremblay, Lise; Lacasse, Yves

doi:10.3747/co.22.2698

Cited by 26 publications

(34 citation statements)

References 15 publications

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“…The sensitivity of pericardial fluid cytology ranges from 66.7% to 92%. This value depends heavily on the gold standard used per study (eg, follow‐up, pericardial biopsy, postmortem autopsy) but nevertheless is considered a valid and useful diagnostic tool 9, 16, 17, 18. Variation also exists between series on what should be classified as a definite malignant effusion; some authors consider cytology‐negative fluid as constituting a malignant effusion if the patient has a known malignancy.…”

Section: Discussionmentioning

confidence: 99%

“…This value depends heavily on the gold standard used per study (eg, follow-up, pericardial biopsy, postmortem autopsy) but nevertheless is considered a valid and useful diagnostic tool. 9,[16][17][18] Variation also exists between series on what should be classified as a definite malignant effusion; some authors consider cytologynegative fluid as constituting a malignant effusion if the patient has a known malignancy. In contrast with these analyses, we chose to limit malignant effusion to those with a proven positive cytology, as determined by a pathologist, and to classify cytology-negative patients as idiopathic in the absence of another plausible cause, even when they had an underlying cancer.…”

Section: Discussionmentioning

confidence: 99%

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Etiology and Long‐Term Outcome of Patients Undergoing Pericardiocentesis

Strobbe

Adriaenssens

Bennett

et al. 2017

JAHA

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BackgroundPericardial effusions can be caused by a variety of disorders. The frequency of the underlying diseases varies with patient population; therefore, previously reported series are not necessarily representative of other populations. Our purpose was to examine the etiology of pericardial effusions and the survival of patients requiring pericardiocentesis at a tertiary center.Methods and ResultsWe performed a retrospective observational study of 269 consecutive patients who underwent percutaneous pericardiocentesis at our university hospital between 2006 and 2016 and had prospective follow‐up for up to 10 years. The most frequent etiologies were idiopathic (26%), malignancy (25%), and iatrogenicity (20%), whereas bacterial causes were very rare. The most frequent malignancies originated from the lung (53%) or breast (18%). A new cancer was diagnosed with malignant pericardial effusion as the presenting complaint for 9% of patients, whereas the pericardium was the first metastatic site of a known malignancy in 4% of patients. Survival was significantly poorer in malignancy‐related versus non–malignancy‐related effusions (P<0.001) and in cytology‐positive versus cytology‐negative effusions in the overall cohort (P<0.001). Among cancer‐only patients, however, there was no significant difference in long‐term survival between cytology‐positive and ‐negative effusions.ConclusionsIn this contemporary tertiary‐center cohort, pericardial effusions often represent the primary instance of a new malignancy, underscoring the importance of cytological analyses of noniatrogenic effusions in patients without known cancer, as survival is significantly worse. In cancer patients, however, the presence of pericardial malignant cytology does not appear to affect outcome significantly.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Etiology and Long‐Term Outcome of Patients Undergoing Pericardiocentesis

Strobbe

Adriaenssens

Bennett

et al. 2017

JAHA

View full text Add to dashboard Cite

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“…The pericardial space can be invaded by direct tumor extension or metastatic spread via lymphatics or blood. Pericardial effusion can also develop as a result of chemotherapy, radiation therapy, or from opportunistic infections (47). …”

Section: Pericardial Diseasesmentioning

confidence: 99%

“…If pericardiocentesis is performed, the drain should be left in place for 3–5 days and surgical pericardial window should be considered if the output drainage is still high 6–7 days after pericardiocentesis. Effusions are more likely to recur with percutaneous pericardiocentesis compared with pericardiotomy, even though there was no difference in length of stay or ICU admission with either approach (47). …”

Section: Pericardial Diseasesmentioning

confidence: 99%

Cardiovascular Complications of Cancer Therapy

Chang

Okwuosa

Scarabelli

et al. 2017

Journal of the American College of Cardiology

245

105

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In this second part of a 2-part review, we will review cancer or cancer-therapy associated systemic and pulmonary hypertension, QT-prolongation, arrhythmias, pericardial disease, and radiation-induced cardiotoxicity. This review is based on MEDLINE literature search, published clinical guidelines, and best practices in major cancer centers. Newly developed targeted therapy can exert off-target effects causing hypertension, thromboembolism, QT-prolongation and atrial fibrillation. Radiation therapy often accelerates atherosclerosis. Furthermore, radiation can damage the heart valves, the conduction system, and pericardium that may take years to manifest clinically. Management of pericardial disease in cancer patients also posed clinical challenges. This review highlights the unique opportunity of caring for cancer patients with heart problems caused by cancer or cancer therapy. It is an invitation to action for cardiologists to become familiar with this emerging subspecialty.

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“…4 Other study involving malignancy cases showed that pericardiocentesis associated with higher recurrence rate as compared with surgical pericardiotomy, however the diagnostic yield and overall complication rate did not significantly differ. 5 Pericardiocentesis with pericardial drainage is safe and effective as the primary treatment for pericardial effusion in patients with malignancy. 6 Surgical drainage of the pericardium is superior to non-surgical approaches for symptom relief, reduced effusion recurrence and lower morbidity.…”

Section: Discussionmentioning

confidence: 99%

Pericardial and Pleural Effusion in Patient with Relapse Stage IV Breast Cancer: Same Pathology, Different Etiology?

Rosalinda

Hartopo

Anggrahini

et al. 2018

Acta Cardiol Indones

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Pericardial effusion associated with malignacy has poor prognosis. The prompt identification of etiology is mandatory, such that timely management can be performed and survival can be increased. However, difficulty in etiology determination is commonly encountered. In this case, we report female patient with relapse stage IV breast cancer who develop massive pericardial and bilateral pleural effusion. The similar characteristics were found in both effusion fluids, however the identification of etiology was not similar. Metastatic cells were found in pleural effusion, whereas they were absent in pericardial effusion. INTISARIEfusi perikard karena keganasan mempunyai prognosis yang buruk. Identifikasi segera dari etiologi merupakan hal yang utama, karena penatalaksanaan yang tepat waktu dapat dilakukan dan angka harapan hidup meningkat. Namun, kesulitan penentuan etiologi seringkali ditemukan. Pada kasus ini, dilaporkan seorang wanita dengan kanker payudara stadium IV kambuh yang mengalami efusi perikard masif dan efusi pleura bilateran. Kedua efusi mempunyai karakteristik yang mirip, namun identifikasi etiologi tidak menunjukkan kesamaan. Sel-sel metastase ditemukan pada efusi pleura, namun tidak dijumpai pada efusi perikard.

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Pericardiocentesis versus Pericardiotomy for Malignant Pericardial Effusion: A Retrospective Comparison

Abstract: Background Treatment of malignant pericardial effusion remains controversial, because no randomized controlled

Cited by 26 publications

References 15 publications

Etiology and Long‐Term Outcome of Patients Undergoing Pericardiocentesis

Etiology and Long‐Term Outcome of Patients Undergoing Pericardiocentesis

Cardiovascular Complications of Cancer Therapy

Pericardial and Pleural Effusion in Patient with Relapse Stage IV Breast Cancer: Same Pathology, Different Etiology?

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