原发性心脏肿瘤术前超声心动图诊断与术后病理诊断的一致性

Consistency between preoperative echocardiography and postoperative pathological diagnosis of primary cardiac tumors

目的探讨原发性心脏肿瘤术前超声心动图诊断与术后病理诊断的一致性。方法收集2017年1月~2021年2月中国科学技术大学附属第一医院诊断并行心脏原发性肿瘤切除的128例患者的临床病理资料,以术后病理诊断结果为标准,将术前超声心动图诊断结果与之对照分析。结果术前超声心动图诊断:心脏恶性肿瘤2例,良性肿瘤126例。良性肿瘤中黏液瘤103例、脂肪瘤1例,另有22例未能明确肿瘤类型。术后病理诊断:恶性肿瘤(均为肉瘤)3例,良性肿瘤125例。良性肿瘤中黏液瘤119例、脂肪瘤5例、血管瘤1例。良性肿瘤术前超声心动图诊断与术后病理诊断的吻合率为99.2%,误诊率为0.8%,术前超声心动图良性肿瘤检出敏感度为100%。其中黏液瘤的术前超声心动图诊断和术后病理诊断吻合率为100%,检出敏感度为86.55%;脂肪瘤吻合率为100%,检出敏感度为20%;血管瘤的心脏超声未检出,敏感度为0;恶性心脏肿瘤吻合率为100%,检出敏感度为66.67%。术前心脏超声心动图诊断肿瘤良、恶性与术后病理诊断的Kappa值为0.796。结论超声心动图诊断心脏原发性肿瘤的良、恶性与病理诊断具有极好的一致性,尤其对黏液瘤的检出敏感度高,而对于其他类型的临床相对少见肿瘤,检出敏感度较低。

Purpose To study the consistency between preoperative echocardiography and the postoperative pathology in the diagnosis of primary cardiac tumors(PCT).Methods 128 patients from January 2017 to February 2021 who were diagnosed as PCT and underwent resection in the First Affiliated Hospital of University of Science and Technology of China were enrolled.The clinical and pathological data were collected for a retrospective analysis.The preoperative echocardiography diagnosis was compared with the results of postoperative pathological diagnoses.Results There were 2 cases of malignant tumor and 126 cases of benign tumor were diagnosed by preoperative echocardiography.Among the benign tumor detected by postoperative pathologyl,there were 103 cases myxoma,1 case of lipoma and there were 22 cases could not define the type of tumor.3 cases of malignant tumor(sarcoma)and 125 cases of benign tumor were diagnosed by postoperative pathology.Among the benign tumors of postoperative pathology,there were 119 cases of myxoma,5 lipoma and 1 hemangioma.The preoperative echocardiography detection agreement rate and misdiagnosis rate for benign tumor were 99.2%and 0.8%,respectively.The sensitivity of preoperative detection of benign cardiac ultrasonography was 100%.The agreement rate of preoperative echocardiography diagnosis of myxoma was 100%compared with pathological diagnosis,and the sensitivity of detection was 86.55%.The agreement rate of lipoma was 100%and the detection sensitivity was 20%.The preoperative echocardiography had not detected the hemangioma with a sensitivity of 0.The agreement rate of malignant cardiac tumor detection by preoperative echocardiography diagnosis was 100%and the sensitivity of detection was 66.67%.The coincidence analysis of preoperative ultrasonography for benign and malignant tumors showed a Kappa value of 0.796.Conclusion The preoperative echocardiography has a good consistency in diagnosis of benign and malignant primary cardiac tumors with pathological diagnosis,especially for myxoma.However,for other tumors whichare infrequent,the detection sensitivity is lower.