Catheter tract metastasis in mesothelioma patients with indwelling pleural catheters
Bibliographic record
Abstract
Background: Indwelling pleural catheters (IPCs) for symptomatic pleural effusions in patients with mesothelioma has increased in popularity. An important concern with this approach is the potential for development of catheter tract metastasis (CTM). Guidelines are conflicted on whether patients should receive prophylactic radiotherapy to the catheter site as limited data exists. We present the largest series of CTM in mesothelioma patients to date. Methods: In this single-center retrospective study, patients with biopsy-confirmed thoracic mesothelioma who had an IPC inserted between 2006 and 2017 were reviewed. Patients were followed until death or last documented patient encounter with a minimum of 6 month follow up. CTM was defined as new, solid chest wall mass identified on CT Thorax (independently confirmed by a thoracic radiologist) at the location of IPC site or new palpable mass identified on clinical exam at IPC site. Results: A total of 90 patients were included in the study with 78 (86.7%) being male. The mean age at diagnosis was 74 years. Eighty-one patients (90%) were dead at the end of follow-up while the remaining nine alive patients (10%) were followed for a mean of 578 days. A total of 24 (26.7%) patients developed CTM with 20 of 24 being confirmed radiographically. Time from IPC insertion to CTM diagnosis was a mean of 457 days. Conclusions: IPCs are an effective therapeutic option for symptomatic malignant pleural effusions associated with mesothelioma. Our data indicates CTM occur in over a quarter of patients receiving IPCs and is higher than previously reported. The discussion on whether these patients should receive prophylactic catheter tract radiation requires revisiting.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".