Histopathology of removed indwelling pleural catheters from patients with malignant pleural diseases

Our plain-English summary of Histopathology of removed indwelling pleural catheters from patients with malignant pleural diseases, by C.L. Tobin, R. Thomas, S.M. Chai, et al (Respirology, 2016).

The study

• Authors: C.L. Tobin, R. Thomas, S.M. Chai, A. Segal, Y.C. Lee
• Journal: Respirology
• Published: 2016;21(5):939-42
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background And Objective: Indwelling pleural catheters (IPC), used for management of malignant pleural effusions, are often left in situ for a long duration. This study reports for the first time the histological findings of IPCs removed from patients with underlying pleural malignancy.

Methods: Forty-one IPCs (in situ for median 126 days, interquartile range 43-226) that were removed over a 54-month period from a single centre were examined.

Results: Mesothelioma (n = 18) was the predominant underlying malignancy followed by breast, tubo-ovarian and lung carcinomas. The catheter tubing was fully intact macroscopically in all IPCs. There was no evidence of direct tumour invasion or cancer cell growth on the catheter surfaces in none of the 29 IPCs that were histologically examined. Malignant cells were seen within organizing fibrinous tissues in the lumen of 11 IPCs (27%). A foreign body giant cell reaction was present at the cuff site in all the 29 IPC in which the subcutaneous cuff was examined. Acute (n = 10) and/or chronic inflammatory changes were seen in the luminal contents in all 41 IPCs.

Conclusion: Our study provides reassuring evidence that the IPC material does not support direct tumour growth or invasion even in the setting of high mesothelioma prevalence. See Editorial, page 787.

© 2016 Asian Pacific Society of Respirology.

In plain English

This study examined 41 indwelling pleural catheters (drainage tubes left in the chest for cancer-related fluid) removed over 54 months from February 2011 at a single centre in Perth, Western Australia. Mesothelioma was the most common underlying cancer (18 patients), followed by breast (9), tubo-ovarian (5) and lung (4) cancers. The catheters had been in place for a median of 126 days. The study did not look at asbestos exposure. For the first 12 catheters only the contents were examined; the other 29 were examined whole. No catheter showed tumour breaching or invading its material. No cancer cells were attached to or growing on the inside of the 29 catheters examined under the microscope. Cancer cells (mesothelioma in 7, tubo-ovarian in 3, lung in 1) were found trapped in fibrin clot material inside 11 of the 41 catheters (27%). All 41 showed inflammation in their contents. The authors concluded this was reassuring evidence of no tumour growth on, or invasion of, the catheters. They said the clinical relevance of the trapped cancer cells is uncertain.

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: Case series: pathology (histological) examination of removed indwelling pleural catheters. For the first 12 cases only the catheter contents were examined; the next 29 catheters were examined whole.
• Who was studied: 41 indwelling pleural catheters removed from 41 patients with malignant pleural disease over a 54-month period from February 2011, at a single centre (Sir Charles Gairdner Hospital, Perth, Western Australia)
• Exposure: Indwelling pleural catheters (silicone drainage catheters) left in place in patients with pleural cancer, for a median of 126 days (interquartile range 43 to 226) before removal. Asbestos exposure was not studied.
• Main results:
  • Underlying cancers among the 41 patients: mesothelioma 18, breast 9, tubo-ovarian 5, lung 4
  • No visible tumour invasion or breach of the catheter was seen in any catheter studied
  • Under the microscope, the catheter tubing was fully intact in all 29 catheters examined, with no direct tumour invasion
  • No cancer cells were attached to or growing on the inner surface of the 29 catheters examined
  • Organized fibrin clots were found inside all catheters
  • Colonies of cancer cells (mesothelioma n=7, tubo-ovarian n=3, lung n=1) were found inside 11 of the 41 catheters (27%)
  • A foreign body giant cell reaction was present at the cuff site in all 29 catheters whose cuff was examined
  • Atypical mesothelial cell proliferation was seen in tissue on the cuff in one case only
  • The catheter contents showed inflammatory changes in all 41 catheters
  • Acute inflammation was found in 10 catheters (24%)
• The authors' conclusion: The authors concluded that their results gave reassuring evidence that there was no tumour cell growth on the catheter material and no tumour interruption of the catheter in their cohort, which had a high proportion of mesothelioma patients.
• Limitations the authors state:
  • The authors stated that the clinical relevance of cancer cells being trapped in fibrin clots inside the catheter is uncertain

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: Histopathology, Indwelling Pleural Catheter, Pleural Effusion, Mesothelioma, Carcinoma.

Related studies

• Protocol of the Australasian Malignant Pleural Effusion-2 (AMPLE-2) trial: a multicentre randomised study of aggressive versus symptom-guided drainage via indwelling pleural catheters — M. Azzopardi, R. Thomas, et al. (2016)
• Catheter tract metastasis associated with indwelling pleural catheters — R. Thomas, C.A. Budgeon, 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)
• 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)
• Catheter Tract Metastasis in Mesothelioma Patients with Indwelling Pleural Catheters: A Retrospective Cohort Study — M.A. Mitchell, P. Li, et al. (2019)
• Predictors of clinical use of pleurodesis and/or indwelling pleural catheter therapy for malignant pleural effusion — E.T.H. Fysh, S. Bielsa, et al. (2015)

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