Percutaneous transcatheter biopsy for intracardiac mass diagnosis.

Gautam Reddy, Elad Maor, Melanie C Bois, Krishnaswamy Chandrasekharan, Charanjit S Rihal, Rick A Nishimura, David R Holmes, Guy S Reeder, Joseph J Maleszewski, Kyle W Klarich

The differential diagnosis of intracardiac masses (ICM) is wide. While imaging modalities cansuggest a diagnosis, clinical decision making usually requires histopathologic diagnosis. The aimwas to describe procedural technique, safety outcomes, diagnostic accuracy and clinical utilityof percutaneous transcatheter biopsy (TCB) for histopathologic diagnosis of ICM. The records ofall patients undergoing TCB of ICM at the Mayo Clinic catheterization laboratories in RochesterMinnesota between 2002 and 2017 were retrieved and reviewed. TCB of ICM to establish histopathologic diagnosis was performed in 29 patients. Masses werelocated in the right-sided chambers in 93% of cases. Echocardiographic guidance was used.Ventricular arrhythmias requiring immediate cardioversion occurred in 7% of patients. No othercomplications were noted. The average number of samples retrieved per procedure was 7 ±3.6. A histopathologic diagnosis was made by TCB in 72% and altered clinical decision making in52% of patients overall. 11 patients (38%) who would have otherwise required excisional biopsywere able to avoid cardiovascular surgery. Each additional biopsy sample was associated withan increase in the likelihood of making a histopathologic diagnosis (OR = 1.74, 95% CI 1.05-2.87,p = 0.032).1.3 Conclusions: Echo-guided percutaneous TCB of ICM provides an accurate diagnosis and alters clinicalmanagement in the majority of cases. The procedural complication rate is low. An increase inthe number of samples retrieved markedly improves the ability to render a diagnosis. TCB maytherefore be considered as a first line approach for the histopathologic diagnosis of ICM.