PURPOSE: Percutaneous pericardial catheter (PPC) drainage is an effective and safe procedure. However, there is controversy about its use in patients with suspected malignant pericardial effusions. Although PPC drainage is less invasive than surgical pericardial window (SPW), a major criticism against its use is the presumed low cytologic yield obtained from pericardial fluid versus the positive histologic yield obtained from the pericardium during SPW. Our aim was to evaluate the diagnostic yield of pericardial fluid cytology vs. pathology in patients undergoing SPW. We further compared the diagnostic yield of cytology obtained by SPW vs PPC.
METHODS: This was a retrospective, case-series study of patients with suspected malignant pericardial effusion. Only patients with a high suspicion of malignancy were included based on history, clinical assessment and radiologic evidence. There were 18 patients in the SPW group and 21 patients in the PPC group. Cytology was reviewed by expert cytopathologists who were blinded to the drainage technique used.
RESULTS: All patients had successful drainage. Of the 18 patients who underwent SPW, 50% (9/18) had positive cytology. However, only 28% (5/18) had positive histology. Of the 21 patients who underwent PPC, 71% (15/21) had either positive cytology or cells highly suspicious of malignancy. Overall, only 4 (19%) patients in the PPC group required additional SPW due to recurrence of effusion. Histology in all these patients was negative.
CONCLUSION: Radiologic identification of intra-thoracic malignancies has greatly improved in the last decade with advanced CT/PET imaging. This allows selection of patients with high likelihood of positive fluid cytology. In such patients, PPC drainage of suspected malignant pericardial effusions has a higher diagnostic yield than surgical pathology obtained via SPW and may thus be more helpful for diagnosis.
CLINICAL IMPLICATIONS: PPC is a minimally invasive procedure that does not require general anesthesia and may allow early hospital discharge and resumption of chemotherapy. Concern over a negative fluid cytology should not be an obstacle to PPC drainage in this group of patients.
DISCLOSURE: M. Jawad Latif, None.