Catheter tract metastasis associated with indwelling pleural catheters

Our plain-English summary of Catheter tract metastasis associated with indwelling pleural catheters, by R. Thomas, C.A. Budgeon, Y.J. Kuok, et al (Chest, 2014).

The study

• Authors: R. Thomas, C.A. Budgeon, Y.J. Kuok, C. Read, E.T.H. Fysh, S. Bydder, Y.C.G. Lee
• Journal: Chest
• Published: 2014;146(3):557-562
• Cited by: 50 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Indwelling pleural catheters (IPCs) are commonly used to manage malignant effusions. Tumor spread along the catheter tract remains a clinical concern for which limited data exist. We report the largest series of IPC-related catheter tract metastases (CTMs) to date, to our knowledge.

Methods: This is a single-center, retrospective review of IPCs inserted over a 44-month period. CTM was defined as a new, solid chest wall lesion over the IPC insertion site and/or the tunneled subcutaneous tract that was clinically compatible with a malignant tract metastasis.

Results: One hundred ten IPCs were placed in 107 patients (76.6% men; 60% with mesothelioma). CTM developed in 11 cases (10%): nine with malignant pleural mesothelioma and two with metastatic adenocarcinoma. CTM often developed late (median, 280 days; range, 56-693) post-IPC insertion. Seven cases had chest wall pain, and six received palliative radiotherapy to the CTM. Radiotherapy was well tolerated, with no major complications and causing no damage to the catheters. Longer interval after IPC insertion was the sole significant risk factor for development of CTM (OR, 2.495; 95% CI, 1.247-4.993; P = .0098) in the multivariate analyses.

Conclusions: IPC-related CTM is uncommon but can complicate both mesothelioma and metastatic carcinomas. The duration of interval after IPC insertion is the key risk factor identified for development of CTM. Symptoms are generally mild and respond well to radiotherapy, which can be administered safely without removal of the catheter.

In plain English

This single-center retrospective review, in Western Australia, studied indwelling pleural catheters (IPCs): tubes left in the chest to drain cancer-related fluid. Between July 31, 2009, and February 28, 2013, 107 patients received 110 IPCs; 66 of the 110 insertions (60%) were in patients with mesothelioma. It examined catheter tract metastasis (CTM): tumor growing along the catheter's path in the chest wall. CTM developed in 11 of 110 cases (10%). Nine had malignant pleural mesothelioma, one breast adenocarcinoma and one ovarian adenocarcinoma. CTM was diagnosed a median of 280 days after insertion (range 56 to 693). Seven patients had chest wall pain. Six completed radiotherapy, and four of them were judged to respond. Four treated with the catheter in place reported no catheter damage. CTM was more common with mesothelioma (13.6%) than with other cancers (4.6%), but this difference was not statistically significant. A longer time since insertion was the only significant risk factor (OR 2.495; 95% CI 1.247 to 4.993). The authors noted small numbers and an incidence skewed by the region's high mesothelioma rate. The article does not discuss asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Single-center retrospective review (case series) of indwelling pleural catheter insertions, drawn from a prospectively kept database
• Who was studied: 107 patients who had 110 indwelling pleural catheters inserted for malignant pleural effusion at one center in Perth, Western Australia, between July 31, 2009, and February 28, 2013. Analysis was done per catheter insertion, and 66 of the 110 insertions (60%) were in patients with mesothelioma.
• Exposure: Insertion of a tunneled indwelling pleural catheter to manage malignant pleural effusion. The article does not study or report asbestos or other fiber exposure.
• Main results:
  • Catheter tract metastasis developed in 11 of 110 IPC insertions (10%): nine in patients with malignant pleural mesothelioma and two in patients with metastatic adenocarcinoma
  • Of the 11 patients with CTM, 9 (81.8%) had mesothelioma, 1 had breast adenocarcinoma and 1 had ovarian adenocarcinoma
  • Among the 11 CTM cases, CTM was diagnosed a median of 280 days (range 56 to 693 days) after catheter insertion
  • Seven of the 11 patients with CTM had chest wall pain, mostly controlled with oral painkillers. One patient needed hospital admission for pain control.
  • Of six patients who completed radiotherapy to the CTM, four were judged to have a clinical response
  • Four patients had their catheter in place during radiotherapy, and none reported catheter damage or malfunction
  • In single-variable analysis, CTM occurred in 13.6% of insertions in patients with mesothelioma versus 4.6% with metastatic pleural carcinomas. The difference was not statistically significant, which the authors attributed to small sample sizes.
  • In multivariate analysis, a longer interval after catheter insertion was the only significant variable predicting higher risk of CTM (OR, 2.495; 95% CI, 1.247-4.993; P = .0098)
  • After adjusting for survival, mesothelioma itself was not an independent risk factor for CTM
• The authors' conclusion: The authors concluded that IPC-related CTM is uncommon but can complicate both mesothelioma and metastatic carcinomas, often as a late complication, with time since insertion the key risk factor. They concluded that radiotherapy appears effective and that removing the catheter is unnecessary.
• Limitations the authors state:
  • The number of CTM cases was small because of its low incidence, and data were collected retrospectively
  • CTM was diagnosed on clinical and radiologic grounds, and tissue (histologic) confirmation was sought only when a mimic was suspected
  • Western Australia has one of the highest incidences of mesothelioma, so the CTM incidence in this study is skewed

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Tract Metastasis, Indwelling Pleural Catheter, Mesothelioma, Pleural Mesothelioma, Adenocarcinoma, Palliative Care, Carcinoma.

Related studies

• Catheter Tract Metastasis in Mesothelioma Patients with Indwelling Pleural Catheters: A Retrospective Cohort Study — M.A. Mitchell, P. Li, et al. (2019)
• Pseudo-tumor mimicking indwelling pleural catheter tract metastasis in mesothelioma — R.L. Shrestha, B.A. Wood, et al. (2014)
• Intrapleural Fibrinolysis for the Treatment of Indwelling Pleural Catheter-Related Symptomatic Loculations: A Multicenter Observational Study — R. Thomas, F. Piccolo, et al. (2015)
• To seed or not to seed: the open question of mesothelioma intervention tract metastases — L. Bertolaccini, A. Viti, et al. (2014)
• Histopathology of removed indwelling pleural catheters from patients with malignant pleural diseases — C.L. Tobin, R. Thomas, et al. (2016)
• Aggressive versus symptom-guided drainage of malignant pleural effusion via indwelling pleural catheters (AMPLE-2): an open-label randomised trial — S. Muruganandan, M. Azzopardi, et al. (2018)

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