Echocardiographic features of cardiac masses can accurately diagnose malignancy

There is no information on the echocardiographic parameters needed for a comprehensive assessment of cardiac masses. Therefore, Pasquale Paolisso from the University of Naples in Federico II, Naples, Italy, and colleagues aimed to identify and integrate the CM's echocardiographic features that can accurately predict malignancy.

For this purpose, the team conducted an observational cohort study of 286 successive patients who underwent a standard echocardiographic examination for suspected cardiac mass in Bologna University Hospital between 2004 and 2022. Histological analysis was used to achieve a definitive diagnosis, or, in the case of cardiac thrombi, with radiological evidence of thrombus resolution after appropriate anticoagulant treatment.

To confirm the ability of six echocardiographic parameters to discriminate malignant from benign masses, logistic and multivariable regression analysis was performed. The unweighted count of these parameters was utilized as a numerical score, varying from 0 to 6, with a cut-off of more than three, balancing specificity and sensitivity concerning the histological diagnosis of malignancy. Classification tree analysis was used to find the ability of echocardiographic parameters to distinguish sub-groups of patients with a differential risk of malignancy.

The study led to the following findings:

· Benign masses were more frequently mobile, pedunculated, and adherent to the interatrial septum.

· Malignant masses demonstrated a greater diameter and exhibited a higher irregular margins frequency, an inhomogeneous appearance, polylobate shape, sessile implantation, and pericardial effusion.

· In both univariate and multivariable models, infiltration, non-left localization, moderate-severe pericardial effusion, polylobate, sessile, and inhomogeneity were confirmed to be independent malignancy predictors.

· The predictive ability of the unweighted count of >3 was very high (>0.90) and similar to that of the previously published weighted score.

· The CTA produced an algorithm in which infiltration was the best distinguisher of malignancy, followed by non-left localization and sessile shape.

· The percentage correctly distinguished by the CTA as malignant was 87.5%.

· The range of agreement between observer readings and cardiac mass histology was between 85.1-91.5%.

· At least three echocardiographic parameters were associated with lower survival.

To conclude, an algorithm was generated that correctly classified 87.5% of the malignancies. These echocardiographic features proved to have also prognostic validity.

Reference:

Paolisso, P., Foà, A., Bergamaschi, L., Graziosi, M., Rinaldi, A., Magnani, I., Angeli, F., Stefanizzi, A., Armillotta, M., Sansonetti, A., Fabrizio, M., Amicone, S., Impellizzeri, A., Tattilo, F. P., Suma, N., Bodega, F., Canton, L., Gherbesi, E., Tuttolomondo, D., . . . Pizzi, C. (2023). Echocardiographic Markers in the Diagnosis of Cardiac Masses. Journal of the American Society of Echocardiography. https://doi.org/10.1016/j.echo.2022.12.022