Use of echocardiography as an essential tool for targeted transcatheter biopsy of cardiac masses

Prejean, Shane; Ahmed, Mohamed; Salama, Ahmed Y.; Akdogan, Raziye E.; Hull, Matthew S.; Watts, Thomas E.; Daya, Hussein Abu; Bajaj, Navkaranbir S.; Nanda, Navin C.; Ahmed, Mustafa I.; Mering, Gregory Von

doi:10.1111/echo.14512

Cited by 3 publications

(5 citation statements)

References 9 publications

(14 reference statements)

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“…Given these tumors are often located in higher risk areas for perforation (atrial or right ventricular free wall), fluoroscopy alone is insufficient for bioptome guidance, and an additional imaging modality is required to guide the procedure. The use of intracardiac echocardiography (ICE) in cardiac procedures has continuously increased since it was first brought into clinical practice many years ago ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

Intracardiac biopsy of cardiac tumors with echocardiographic guidance: Case report

Zhu

Zhang

et al. 2023

Front. Cardiovasc. Med.

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BackgroundPrimary cardiac tumors are very rare, and about 20–30% of them are malignant tumors. Since early signs of cardiac tumors are non-specific, diagnosis can be challenging. There is a lack of the recommended guidelines or standardized strategies for diagnosis and optimal treatment for this disease. As the definite diagnoses of most tumors are made by pathologic confirmation, biopsied tissue is essential in determining the treatment for patients with cardiac tumors. Recently, intracardiac echocardiography (ICE) has been introduced to assist biopsy procedures of cardiac tumors and it provides high-quality imaging.Case DescriptionDue to its low prevalence and variable presentation, cardiac malignant tumors usually are easily missed. Hereby, we report three cases of patients who presented with non-specific signs of cardiac disorder and was initially suspended diagnosis as lung infection or cancer. Under the guidance of ICE, cardiac biopsies were successfully on cardiac masses, giving critical data for diagnosis and treatment planning. No procedural complications were obtained in our cases. These cases are intended to highlight the clinical value and importance of ICE-guided biopsy of intracardiac mass.ConclusionsThe diagnosis of primary cardiac tumors relies on the histopathological results. In our experience, using ICE for biopsy of an intracardiac mass is an attractive tool to increase diagnostic results and reduce the risk of cardiac complications associated with inadequate targeting of the biopsy catheters.

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Section: Discussionmentioning

confidence: 99%

Intracardiac biopsy of cardiac tumors with echocardiographic guidance: Case report

Zhu

Zhang

et al. 2023

Front. Cardiovasc. Med.

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“…In patients with multiorgan involvement, lesions involving the most accessible organ should be biopsied. 9 The use of TCB has been increasingly described to establish a histopathologic diagnosis of cardiac tumors. 10 Echocardiography-guided TCB is widely used because of its excellent safety profile.…”

Section: Discussionmentioning

confidence: 99%

“…TTE and TEE offer the advantage of site-specific biopsy and avoiding local damage. 9 The three main echocardiographic modalities are TTE, 11 TEE, 12,13 and intracardiac echocardiography (ICE). 14 The advantages of TTE include portability, availability, and cost-effectiveness compared with TEE and ICE.…”

Section: Discussionmentioning

confidence: 99%

“…11 TEE, which is also widely accessible, provides better image quality, especially when assessing posterior cardiac structures, which are in close proximity to the esophagus. 9 TEE is considered superior to CMR in characterizing masses that are highly mobile or adjacent to cardiac valves, such as vegetations or papillary fibroelastoma, because of spatial and temporal resolution. 7 Compared with TEE, ICE offers similar or greater image quality while also obviating the need for general anesthesia and a second echocardiographer.…”

Section: Discussionmentioning

confidence: 99%

“…11 Ultimately the choice of imaging modality depends on availability, institutional experience, and the requirements of the patient. 9 The treatment for metastatic GCT to the heart is dependent on the extent of cardiac tissue involvement. Treatment modalities include chemotherapy, radiation therapy, and surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Role of Echocardiography in Diagnosing Metastatic Testicular Carcinoma in a Young Patient Presenting as Right Heart Failure

Mahalwar

Barve

Furqan

et al. 2022

CASE

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Primary Cardiac Intimal Sarcoma: Multi-Layered Strategy and Core Role of MDM2 Amplification/Co-Amplification and MDM2 Immunostaining

Nistor,

Stanciu Gavan,

Birceanu

et al. 2024

Diagnostics

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Primary cardiac tumours are relatively uncommon (75% are benign). Across the other 25%, representing malignant neoplasia, sarcomas account for 75–95%, and primary cardiac intimal sarcoma (PCIS) is one of the rarest findings. We aimed to present a comprehensive review and practical considerations from a multidisciplinary perspective with regard to the most recent published data in the specific domain of PCIS. We covered the issues of awareness amid daily practice clinical presentation to ultra-qualified management in order to achieve an adequate diagnosis and prompt intervention, also emphasizing the core role of MDM2 immunostaining and MDM2 genetic analysis. An additional base for practical points was provided by a novel on-point clinical vignette with MDM2-positive status. According to our methods (PubMed database search of full-length, English publications from January 2021 to March 2023), we identified three studies and 23 single case reports represented by 22 adults (male-to-female ratio of 1.2; male population with an average age of 53.75 years, range: 35–81; woman mean age of 55.5 years, range: 34–70) and a 4-year-old child. The tumour-related clinical picture was recognized in a matter of one day to ten months on first admission. These non-specific data (with a very low index of suspicion) included heart failure at least NYHA class II, mitral regurgitation and pulmonary hypertension, acute myocardial infarction, ischemic stroke, obstructive shock, and paroxysmal atrial fibrillation. Awareness might come from other complaints such as (most common) dyspnoea, palpitation, chest pressure, cough, asthenia, sudden fatigue, weakness, malaise, anorexia, weight loss, headache, hyperhidrosis, night sweats, and epigastric pain. Two individuals were initially misdiagnosed as having endocarditis. A history of prior treated non-cardiac malignancy was registered in 3/23 subjects. Distant metastasis as the first step of detection (n = 2/23; specifically, brain and intestinal) or during follow-up (n = 6/23; namely, intestinal, brain and bone, in two cases for each, and adrenal) required additional imagery tools (26% of the patients had distant metastasis). Transoesophageal echocardiography, computed tomography (CT), magnetic resonance imagery, and even 18F-FDG positronic emission tomography-CT (which shows hypermetabolic lesions in PCIS) represent the basis of multimodal tools of investigation. Tumour size varied from 3 cm to ≥9 cm (average largest diameter of 5.5 cm). The most frequent sites were the left atrium followed by the right ventricle and the right atrium. Post-operatory histological confirmation was provided in 20/23 cases and, upon tumour biopsy, in 3/23 of them. The post-surgery maximum free-disease interval was 8 years, the fatal outcome was at the earliest two weeks since initial admission. MDM2 analysis was provided in 7/23 subjects in terms of MDM2-positive status (two out of three subjects) at immunohistochemistry and MDM2 amplification (four out of five subjects) at genetic analysis. Additionally, another three studies addressed PCISs, and two of them offered specific MDM2/MDM2 assays (n = 35 patients with PCISs); among the provided data, we mention that one cohort (n = 20) identified a rate of 55% with regard to MDM2 amplification in intimal sarcomas, and this correlated with a myxoid pattern; another cohort (n = 15) showed that MDM2-positive had a better prognostic than MDM2-negative immunostaining. To summarize, MDM2 amplification and co-amplification, for example, with MDM4, CDK4, HMGA3, CCND3, PDGFRA, TERT, KIT, CCND3, and HDAC9, might improve the diagnosis of PCIS in addition to MDM2 immunostaining since 10–20% of these tumours are MDM2-negative. Further studies are necessary to highlight MDM2 applicability as a prognostic factor and as an element to be taken into account amid multi-layered management in an otherwise very aggressive malignancy.

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Use of echocardiography as an essential tool for targeted transcatheter biopsy of cardiac masses

Cited by 3 publications

References 9 publications

Intracardiac biopsy of cardiac tumors with echocardiographic guidance: Case report

Intracardiac biopsy of cardiac tumors with echocardiographic guidance: Case report

Role of Echocardiography in Diagnosing Metastatic Testicular Carcinoma in a Young Patient Presenting as Right Heart Failure

Primary Cardiac Intimal Sarcoma: Multi-Layered Strategy and Core Role of MDM2 Amplification/Co-Amplification and MDM2 Immunostaining

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