DIAGNOSIS, LOCALIZATION AND EVALUATION OF MALIGNANCY OF HEART AND MEDIASTINAL TUMORS BY CONVENTIONAL AND TRANSESOPHAGEAL ECHOCARDIOGRAPHY

Transesophageal echocardiography is well established in detecting and diagnosing heart tumors. In contrast, its role in assessing presence, growth and evidence of malignancy of tumors originating from the media stinal site remains widely uncertain. In a prospective and investigato r-blind study, we evaluated 72 consecutive patients with cardiac and/o r mediastinal tumor lesions to assess the diagnostic impact of transth oracic and transesophageal echocardiography in determining localizatio n, growth and malignancy. All tumor lesions were diagnosed and careful ly evaluated by computer tomography and/or magnetic resonance imaging prior to the study. Biopsy demonstrated a malignant tumor in 49 patien ts and a benign tumor in 23 patients. Transthoracic and transesophagea l echocardiography were equally effective in visualizing tumors of the heart in 24 patients (92% vs 100%; N.S.). Tumors originating from the mediastinum were 2.9 times less likely to be detected by the transtho racic approach (p <0.001). In these patients, transesophageal echocard iography was also superior in diagnosing myocardial infiltration (18 v s 4 patients, P <0.05). When compared to histological findings, transe sophageal echocardiography predicted malignancy from the presence of t umor spread both in- and outside the heart, infiltration and invasion in 21/49 patients (43%), a false positive result was obtained in only 1/23 patients with a benign tumor. Conventional echocardiography predi cted malignancy in only 4/49 patients (8%, p <0.005). In conclusion, t ransesophageal echocardiography is increasingly used in patients with suspected mediastinal tumor lesions. Our study demonstrates, that tran sesophageal echocardiography is effective and superior to the conventi onal approach in predicting localization and growth of mediastinal tum ors, as well as in assessing evidence of malignancy of the tumor.