Cardiac invasion by bronchial carcinoma may prevent successful resection but may be undetected before operation. In a retrospective analysis of 100 consecutive thoracotomies nine patients had unsuspected cardiac invasion by tumour. A prospective study of preoperative two dimensional echocardiography was therefore undertaken in patients with bronchial carcinoma who had no clinical evidence of cardiac tumour. Comparison with anatomical findings was possible in 65 patients in whom an echocardiogram of suitable quality had been obtained. There was one false negative among 55 negative echocardiograms and three false positives among 10 positive echocardiograms; non-malignant pericardial disease accounted for the echocardiographic finding in one of the latter. The predictive value of a negative test was 98%, and the predictive value of a positive test was highest (80%) if the echocardiogram suggested atrial invasion.
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