CARDIAC TUMOURS: THREE DECADES OF EXPERIENCE FROM A TERTIARY CENTRE: Are we changing diagnostic work-up with new imaging tools?

ABSTRACT Background Primary cardiac tumours are relatively rare. Cardiac myxomas are the most prevalent and in a significant proportion of cases they are accidentally discovered in asymptomatic patients. Non-invasive definitive diagnosis remains challenging despite improvements provided by newer imaging tools. Our aim was to describe the long-term experience of a tertiary cardiac centre managing cardiac tumours. Methods We analysed 154 consecutive patients admitted to a single - tertiary centre with the diagnosis of a cardiac mass or tumour between 1990 and 2018. Data files including clinical presentation, non-invasive investigations, presumptive diagnosis and histopathology were collected. The follow-up was obtained from clinical records or telephone contact. Results In 154 patients with a median age at diagnosis of 61 [51-71] years, 62% were females. Anatomo-pathology study was obtained in 144 cases, from which 81% were benign tumours (106 myxomas; 11 papillary fibroelastomas). In comparison with malignant lesions, patients with benign tumours were older (62 versus 48 years) and more often women (65% versus 27%, p=0,021). Incidental diagnosis of a benign tumour occurred in 36% of the cases. Transthoracic echocardiography was the initial technique for diagnostic suspicion in the great majority of patients. Both cardiac computed tomography and magnetic resonance were rarely performed before excision. Imaging based (mostly echocardiography) pre-operative presumptive diagnosis was discordant with histopathologic findings in 21% of the benign and in 55% of malignant lesions (previously considered as benign). Uncommon histologic findings were found in 18% of myxomas. During the follow-up period of 11 ± 12 years there were 12 recurrences. Conclusion Among surgically excised cardiac tumours benign cardiac tumours are far more common than both primary and secondary malignancies. In this series of patients there was a significant proportion of asymptomatic lesions. Pre-operative misdiagnosis could be related to the scarce use of adjunctive non-invasive imaging tools beyond echocardiography. Preoperative non-invasive investigation should be expanded to improve diagnostic presumption and better plan the best therapeutic approach.