[Consensus document on endomyocardial biopsy of the Associazione per la Patologia Cardiovascolare Italiana].
The Italian Scientific Associations of Cardiologists and Cardiovascular Pathologists have produced this consensus document on the diagnostic role of endomyocardial biopsy (EMB) in terms of techniques, analysis and reporting. The document is intended for clinical cardiologists, hemodynamic experts, electrophysiologists, surgical pathologists, and cardiac surgeons. It has three main aims: a) to collocate EMB in the context of currently available tools for diagnosis of heart diseases; b) to provide recommendations for rational implementation; c) to outline key characteristics (standards) for Italian cardiology and surgical pathology centers that perform and analyze EMB. A general lack of prospective, controlled studies addressing EMB prohibited the use of traditional evidence-based recommendations that rely on classes of available evidence. Thus, it was agreed that three key points should be taken into account: a) the specific pathology to be diagnosed (or excluded); b) the existence of any alternative, non-invasive diagnostic techniques; c) the overall consequences of reaching a definite diagnosis on patients' clinical management. Accordingly, we propose recommendations for EMB based on the following levels of diagnostic value: level 1: no alternative method exists to reach a definite diagnosis that can have obvious consequences for clinical management; level 2a: no alternative method exists to reach a definite diagnosis; however, the implications for clinical management are uncertain; level 2b: no alternative method exists to reach a definite diagnosis; however, the diagnosis would not influence clinical management; level 3: an alternative method exists to reach a definite diagnosis. The second part of the document proposes current protocols for the preparation, analysis and reporting of EMB in the context of each main pathologic entity. Particular attention is given to tissue characterization and implementation of molecular tests.
Leone
Ornella
O
Anatomia Patologica, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Via Massarenti, 9 40138 Bologna. ornella.leone@aosp.bo.it
Rapezzi
Claudio
C
Sinagra
Gianfranco
G
Angelini
Annalisa
A
Arbustini
Eloisa
E
Bartoloni
Giovanni
G
Basso
Cristina
C
Caforio
Alida L P
AL
Calabrese
Fiorella
F
Coccolo
Fabio
F
d'Amati
Giulia
G
Mariesi
Emiliano
E
Milanesi
Ornella
O
Nodari
Savina
S
Oliva
Fabrizio
F
Perkan
Andrea
A
Prandstraller
Daniela
D
Pucci
Angela
A
Ramondo
Angelo
A
Silvestri
Furio
F
Valente
Marialuisa
M
Thiene
Gaetano
G
D000686:Amyloidosis / Q000473:pathology; D001706:Biopsy / Q000379:methods / Q000592:standards; D002985:Clinical Protocols; D006331:Heart Diseases / Q000139:chemically induced / Q000473:pathology*; D006338:Heart Neoplasms / Q000473:pathology; D016027:Heart Transplantation / Q000473:pathology; D006801:Humans; D019190:Iron Overload / Q000473:pathology; D028361:Mitochondrial Diseases / Q000473:pathology; D009205:Myocarditis / Q000473:pathology; D009206:Myocardium / Q000473:pathology*