Pericardoscopy for primary management of pericardial effusion in cancer patients

Objective: To assess the usefulness of pericardoscopy via the subxyphoid ro ute for the diagnosis and treatment of pericardial effusion in patients wit h a history of cancer. Methods: All patients with a recent or remote histor y of cancer and a pericardial effusion of unknown origin requiring drainage for diagnostic and therapeutic purposes were included in the study. They u nderwent complete exploration and cleansing of the pericardial cavity. Abno rmal structures or deposits were biopsied under direct visual control, with a 24 cm long rigid pericardoscope. Results: Between 1985 and 1998, pericar doscopy was completed in 112 of the 114 patients included (feasibility 98%) , resulting in the immediate relief of symptoms in all the cases. Peri-oper ative mortality was 3.5%, and post-operative morbidity, 6.1%. After pericar dioscopy pericardial effusions were considered malignant in 43 cases. One m ore case (2.3%) due to a false negative result of perycardioscopy was diagn osed during follow-up. Overall, 44 of the 114 patients (38.6%) had a malign ant 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 stu dies 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%, resp ectively. One patient with a malignant effusion had a non-symptomatic recur rence 1 month after pericardioscopy (2.3%). Conclusion: We recommend perica rdioscopy to ascertain the malignant nature of the effusion and to diminish the recurrence rare, this avoiding repeat procedures in patients with a sh ort life expectancy. (C) 1999 Elsevier Science B.V. All rights reserved.