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(Circulation. 2003;107:978.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Diagnostic Value of Pericardial Biopsy

Improvement With Extensive Sampling Enabled by Pericardioscopy

Petar M. Seferovi, MD, PhD, FESC; Arsen D. Risti, MD, FESC; Ruica Maksimovi, MD, PhD; Vujadin Tati, MD, PhD; Miodrag Ostoji, MD, PhD, FESC; Vladimir Kanjuh, MD, PhD

From the University Institute for Cardiovascular Diseases of the Medical Center of Serbia and Institute of Pathology and Forensic Medicine, Military Medical Academy (V.T.), Belgrade, Yugoslavia.

Correspondence to Petar M. Seferovi, MD, PhD, FACC, FESC, Professor and Head, Department of Cardiology 2, University Institute for Cardiovascular Diseases, Medical Center of Serbia, Koste Todorovica 8, 11000 Belgrade, Yugoslavia. E-mail eseferov{at}eunet.yu

Background— The clinical significance of pericardial biopsy is controversial. The aim of this study was to assess the feasibility and diagnostic value of 3 approaches to pericardial biopsy: fluoroscopic control and standard sampling, pericardioscopy guidance with standard sampling, and pericardioscopy guidance with extensive sampling.

Methods and Results— Forty-nine subsequent patients with a large pericardial effusion underwent parietal pericardial biopsy. In group 1 (12 patients, 66.7% males, age 46.7±12.2 years), pericardial biopsy was guided by fluoroscopy (3 to 6 samples per patient). Group 2 included 22 patients (50% males, age 50.8±10.4 years) undergoing 4 to 6 pericardial biopsies per patient guided by pericardioscopy (16F flexible endoscope). In group 3, extensive pericardial sampling was performed, guided by pericardioscopy (15 patients, 53.3% males, age 53.7±12.8 years, 18 to 20 samples per patient). Sampling efficiency was better with pericardioscopy (group 2, 84.9%; group 3, 84.2%) compared with fluoroscopic guidance (group 1, 43.7%; P<0.01). Diagnostic value was defined as a new diagnosis uncovered, etiology revealed, clinical diagnosis confirmed, and the biopsy false-negative. Pericardial biopsy in group 3 had higher diagnostic value than in group 1 in revealing new diagnosis (40% versus 8.3%, P<0.05) and etiology (53.3% versus 8.3%, P<0.05). In group 2, pericardial biopsy had a higher yield in establishing etiology than in group 1 (40.9% versus 8.3%; P<0.05). Pericardial biopsy was false-negative in 58.3% in group 1 in contrast to 6.7% in group 3 (P<0.01). There were no major complications.

Conclusions— Pericardioscopic guidance enhanced pericardial sampling efficiency. The diagnostic value of pericardial biopsy was significantly improved by extensive sampling made possible by pericardioscopy.

Key Words: biopsy • diagnosis • pericarditis • pericardium

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