Seferović Petar M, Ristić Arsen D, Maksimović Ruzica, Tatić Vujadin, Ostojić Miodrag, Kanjuh Vladimir
Department of Cardiology 2, University Institute for Cardiovascular Diseases of the Medical Center of Serbia. Belgrade, Yugoslavia.
Circulation. 2003 Feb 25;107(7):978-83. doi: 10.1161/01.cir.0000051366.97361.ea.
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.
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.
Pericardioscopic guidance enhanced pericardial sampling efficiency. The diagnostic value of pericardial biopsy was significantly improved by extensive sampling made possible by pericardioscopy.
心包活检的临床意义存在争议。本研究的目的是评估心包活检的三种方法的可行性和诊断价值：透视引导下标准取材、心包镜引导下标准取材以及心包镜引导下广泛取材。
49例连续的大量心包积液患者接受了壁层心包活检。第1组（12例患者，男性占66.7%，年龄46.7±12.2岁），心包活检在透视引导下进行（每位患者取3至6块组织）。第2组包括22例患者（男性占50%，年龄50.8±10.4岁），在心包镜（16F可弯曲内镜）引导下每位患者进行4至6次心包活检。第3组，在心包镜引导下进行广泛的心包取材（15例患者，男性占53.3%，年龄53.7±12.8岁，每位患者取18至20块组织）。与透视引导（第1组，43.7%）相比，心包镜引导下的取材效率更高（第2组，84.9%；第3组，84.2%；P<0.01）。诊断价值定义为发现新诊断、揭示病因、证实临床诊断以及活检假阴性。第3组心包活检在发现新诊断（40%对8.3%，P<0.05）和病因（53.3%对8.3%，P<0.05）方面比第1组具有更高的诊断价值。在第2组中的心包活检在确定病因方面比第1组有更高的阳性率（40.9%对8.3%；P<0.05）。第1组心包活检假阴性率为58.3%，而第3组为6.7%（P<0.01）。无严重并发症发生。
心包镜引导提高了心包取材效率。心包镜下实现的广泛取材显著提高了心包活检的诊断价值。
