Echocardiographic malignancy probability vs histopathology in cardiac masses: a tertiary-centre experience
C Bonilla Rodriguez, A Jimenez Preciado, D Fimbres Moreno, K Bonilla Rodriguez, K Martinez Perales, M Morales GonzalezAbstract
Background
Intracardiac masses can originate from either primary malignant, metastatic, or benign condition and frequently requiere urgent cardio-oncologic evaluation. The primary imaging modality for initial assessment of these masses remains the transastoracic echocardiograph (TTE), but distinguishing malignant disease from benign or non-neoplastic continues to be a challenge. The Diagnostic Echocardiographic Mass (DEM) score integrates echocardiographic characteristics to estimate probability of malignancy.
Objective
To evaluate the agreement between malignancy probability derived from DEM Score and definitive histopathology results of intracardiac masses in a tertiary care center.
Methodology
Retrospective, observational study conducted from January 2025 to December 2025 at a tertiary care center. Patients diagnosed with an intracardiac mass via TTE and later studied via histopathology analysis were included. The probability of malignancy was estimated utilizing DEM score, as low (0-2), intermediate (3-4), or high (>4) risc. The agreement between DEM score and histopathology results. The agreement between DEm score and histopathology was evaluated using Cohen’s weighted kappa (linear weights).
Results
A total of 20 pacientes were included. The most frequent location for intracardiac masses was the left atrium (65%), followed by right atrium (20%), and right ventricle (15%). DEM score categories were low in a total of 15 (75%) patients, intermediate in 3 (15%), and high in 2 (10%). Final Histopathology results reported myxoma in 12 (60%), vegetations in 6 (30%), and malignant disease in 2 (10%) (sarcoma or metastasis) patients. Overall agreement between DEM score categories and histopathology results was 85% (weighted kappa 0.76; 95% CI 0.35–1.00).
Conclusion
In a tertiary-care-centre cohort, the DEM score showed adequate agreement with final Histopathology diagnosis of intracardiac masses and may support early identification of malignant disease. This approach could aid triage and expedited the decision for cross-sectional imaging, multidisciplinary cardio-oncology review, and surgical planning.Resected myxoma of the left atrium Adenocarcinoma metastasis