Preoperative transesophageal echocardiography for assessment of vena caval tumor thrombi: a comparative study with venacavography and magnetic resonance imaging.

OBJECTIVES: Renal cell carcinoma extends into the inferior vena cava (IVC) in 4% to 10% of patients. The purpose of this study was to evaluate the diagnostic accuracy of preoperative transesophageal echocardiography (TEE) in determining the presence and level of IVC involvement in such cases.

METHODS: From June 1992 to December 1995, 13 patients with suspected IVC tumor thrombi were studied with preoperative TEE. These patients were also evaluated with either magnetic resonance imaging (MRI; n = 10), contrast venacavography (CVC; n = 8), or both of the latter (n = 5). All patients subsequently underwent surgical removal of the primary tumor and IVC thrombus. The presence and level of IVC thrombus at surgery was correlated with that predicted by the various preoperative imaging modalities.

RESULTS: Preoperative TEE accurately delineated the presence and extent of IVC tumor thrombus involvement in 11 of 13 patients (85%); the level of IVC involvement was overstaged in 1 patient and understaged in 1 patient. Accurate diagnostic information was provided by MRI in 9 of 10 patients (90%) and by CVC in 6 of 8 patients (75%).

CONCLUSIONS: In patients with IVC tumor thrombi, preoperative TEE can provide accurate information regarding the presence and extent of IVC involvement. However, TEE is an invasive and costly procedure with no diagnostic advantage over MRI in the preoperative evaluation of these patients.