Geibel A, Kasper W, Keck A, Hofmann T, Konstantinides S, Just H
Medizinische Klinik III, Albert-Ludwigs-Universität Freiburg, Germany.
Acta Cardiol. 1996;51(5):395-408.
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 mediastinal site remains widely uncertain. In a prospective and investigator-blind study, we evaluated 72 consecutive patients with cardiac and/or mediastinal tumor lesions to assess the diagnostic impact of transthoracic and transesophageal echocardiography in determining localization, growth and malignancy. All tumor lesions were diagnosed and carefully evaluated by computer tomography and/or magnetic resonance imaging prior to the study. Biopsy demonstrated a malignant tumor in 49 patients and a benign tumor in 23 patients. Transthoracic and transesophageal 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 transthoracic approach (p < 0.001). In these patients, transesophageal echocardiography was also superior in diagnosing myocardial infiltration (18 vs 4 patients, p < 0.001) and invasion or intracardiac growth of the tumor (13 vs 6 patients, p < 0.05). When compared to histological findings, transesophageal echocardiography predicted malignancy from the presence of tumor 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 predicted malignancy in only 4/49 patients (8%, p < 0.005). In conclusion, transesophageal echocardiography is increasingly used in patients with suspected mediastinal tumor lesions. Our study demonstrates, that transesophageal echocardiography is effective and superior to the conventional approach in predicting localization and growth of mediastinal tumors, as well as in accessing evidence of malignancy of the tumor.
经食管超声心动图在检测和诊断心脏肿瘤方面已得到广泛认可。相比之下，其在评估起源于纵隔部位肿瘤的存在、生长及恶性证据方面的作用仍存在很大不确定性。在一项前瞻性且研究者盲法的研究中，我们评估了72例连续的患有心脏和/或纵隔肿瘤病变的患者，以评估经胸和经食管超声心动图在确定肿瘤定位、生长及恶性程度方面的诊断价值。在研究前，所有肿瘤病变均通过计算机断层扫描和/或磁共振成像进行诊断和仔细评估。活检显示49例为恶性肿瘤，23例为良性肿瘤。经胸和经食管超声心动图在观察24例患者的心脏肿瘤方面同样有效（92%对100%；无显著性差异）。经胸途径检测起源于纵隔的肿瘤的可能性要低2.9倍（p<0.001）。在这些患者中，经食管超声心动图在诊断心肌浸润（18例对4例，p<0.001）以及肿瘤的浸润或心内生长（13例对6例，p<0.05）方面也更具优势。与组织学结果相比，经食管超声心动图根据心脏内外肿瘤扩散、浸润和侵犯的情况在21/49例患者（43%）中预测为恶性，在仅1/23例良性肿瘤患者中出现假阳性结果。传统超声心动图仅在4/49例患者（8%，p<0.005）中预测为恶性。总之，经食管超声心动图在疑似纵隔肿瘤病变的患者中应用越来越多。我们的研究表明，经食管超声心动图在预测纵隔肿瘤的定位和生长以及评估肿瘤恶性证据方面有效且优于传统方法。
