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Li H, Lu Y, Zeng X, Feng Y, Fu C, Duan H, Shu Q, Zhu J. Risk factors for central venous catheter-associated deep venous thrombosis in pediatric critical care settings identified by fusion model. Thromb J 2022; 20:18. [PMID: 35414086 PMCID: PMC9004113 DOI: 10.1186/s12959-022-00378-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 03/29/2022] [Indexed: 12/03/2022] Open
Abstract
Background An increase in the incidence of central venous catheter (CVC)-related thrombosis (CRT) has been reported in pediatric intensive care patients over the past decade. Risk factors for the development of CRT are not well understood, especially in children. The study objective was to identify potential clinical risk factors associated with CRT with novel fusion machine learning models. Methods Patients aged 0–18 who were admitted to intensive care units from December 2015 to December 2018 and underwent at least one CVC placement were included. Two fusion model approaches (stacking and blending) were used to build a better performance model based on three widely used machine learning models (logistic regression, random forest and gradient boosting decision tree). High-impact risk factors were identified based on their contribution in both fusion artificial intelligence models. Results A total of 478 factors of 3871 patients and 3927 lines were used to build fusion models, one of which achieved quite satisfactory performance (AUC = 0.82, recall = 0.85, accuracy = 0.65) in 5-fold cross validation. A total of 11 risk factors were identified based on their independent contributions to the two fusion models. Some risk factors, such as D-dimer, thrombin time, blood acid-base balance-related factors, dehydrating agents, lymphocytes and basophils were identified or confirmed to play an important role in CRT in children. Conclusions The fusion model, which achieves better performance in CRT prediction, can better understand the risk factors for CRT and provide potential biomarkers and measures for thromboprophylaxis in pediatric intensive care settings. Supplementary information The online version contains supplementary material available at 10.1186/s12959-022-00378-y.
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Affiliation(s)
- Haomin Li
- The Children's Hospital of Zhejiang University School of Medicine and National Clinical Research Center for Child Health, Hangzhou, China. .,Clinical Data Center, The Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, 310052, Hangzhou, China.
| | - Yang Lu
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Xian Zeng
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Yuqing Feng
- The Children's Hospital of Zhejiang University School of Medicine and National Clinical Research Center for Child Health, Hangzhou, China.,Clinical Data Center, The Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, 310052, Hangzhou, China
| | - Cangcang Fu
- The Children's Hospital of Zhejiang University School of Medicine and National Clinical Research Center for Child Health, Hangzhou, China.,Department of Nursing, The Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, 310052, Hangzhou, China
| | - Huilong Duan
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Qiang Shu
- The Children's Hospital of Zhejiang University School of Medicine and National Clinical Research Center for Child Health, Hangzhou, China
| | - Jihua Zhu
- The Children's Hospital of Zhejiang University School of Medicine and National Clinical Research Center for Child Health, Hangzhou, China. .,Department of Nursing, The Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, 310052, Hangzhou, China.
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Brgdar A, Ojo AS, Rougui L, Anee K, Sumon M, Mehari A. Pulmonary Embolism and Chronic Superior Vena Cava Occlusion Complicating Central Line-Associated Venous Thromboembolism in a Sickle Cell Disease Patient. Cureus 2022; 14:e22113. [PMID: 35308691 PMCID: PMC8918275 DOI: 10.7759/cureus.22113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 12/05/2022] Open
Abstract
Sickle cell disease (SCD), the most common genetic disorder globally, is often associated with an increased risk of venous thromboembolic events (VTE). Many of these patients have central lines placed for the purposes of repeated medication administration, blood transfusions, and blood draw, further increasing the risk of VTE. Given the non-specific presentation of VTE and pulmonary embolism, as well as the risk of mortality if interventions are delayed, a high index of suspicion is required for early diagnosis of the condition. We report the case of a 35-year-old woman with SCD and a port-a-cath in place who presented with extensive upper extremity and intrathoracic VTE with associated pulmonary embolism and chronic superior vena cava (SVC) occlusion. We also discuss the peculiarities of the clinical manifestations and management of VTE and pulmonary embolism in the setting of SCD based on the evidence from existing literature.
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Lee J, Hur SM, Kim Z, Lim CW. Safety of immediate use of totally implantable venous access ports in adult patients with cancer: a retrospective single-center study. KOREAN JOURNAL OF CLINICAL ONCOLOGY 2021; 17:104-110. [PMID: 36945672 PMCID: PMC9942755 DOI: 10.14216/kjco.21016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/08/2021] [Indexed: 01/17/2023]
Abstract
Purpose Totally implantable venous access ports (TIVAPs) can be used long-term for safe administration of intravenous drugs. TIVAP complications include catheter-related infections, venous thrombosis, extravasation, TIVAP migration, and pain. The relationship between the timing of the first chemotherapy administration after port implantation and complications is controversial. This study aimed to investigate the safety of immediate use of TIVAPs and the associated risk factors for complications. Methods Between January 2016 and December 2018, 305 patients (median age, 53 years; 256 women) who underwent TIVAP placement at our institution were included. Chemotherapy was administered within 2 days of implantation. A retrospective analysis of patients' clinical data was performed to investigate catheter days and complications of TIVAPs. Results Overall, 305 patients were evaluated over 57,324 catheter days (median, 168 catheter days; interquartile range, 105). The median interval between placement and first use of TIVAPs was 0.98 days. The overall morbidity rate was 2.95%. Nine complications occurred in nine patients, including TIVAP-related infection (4), pain (2), port occlusion (1), thrombosis (1), and scar disunion (1), of which five required port removal (1.64%). The median number of catheter days before complications occurred was 61 (range, 10-457 days; interquartile range, 51). No complications occurred within 7 days of implantation. Body mass index was an independent risk factor for TIVAP-related complications in the Cox proportional hazards model (multivariable analysis: hazard ratio, 1.221; 95% confidence interval, 1.054-1.414; P=0.008). Conclusion This study suggests the safe long-term use of TIVAPs following their immediate chemotherapy administration within 2 days of implantation.
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Affiliation(s)
- Jisu Lee
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sung Mo Hur
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Zisun Kim
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Cheol Wan Lim
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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Li H, Lu Y, Zeng X, Fu C, Duan H, Shu Q, Zhu J. Prediction of central venous catheter-associated deep venous thrombosis in pediatric critical care settings. BMC Med Inform Decis Mak 2021; 21:332. [PMID: 34838025 PMCID: PMC8627017 DOI: 10.1186/s12911-021-01700-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND An increase in the incidence of central venous catheter (CVC)-associated deep venous thrombosis (CADVT) has been reported in pediatric patients over the past decade. At the same time, current screening guidelines for venous thromboembolism risk have low sensitivity for CADVT in hospitalized children. This study utilized a multimodal deep learning model to predict CADVT before it occurs. METHODS Children who were admitted to intensive care units (ICUs) between December 2015 and December 2018 and with CVC placement at least 3 days were included. The variables analyzed included demographic characteristics, clinical conditions, laboratory test results, vital signs and medications. A multimodal deep learning (MMDL) model that can handle temporal data using long short-term memory (LSTM) and gated recurrent units (GRUs) was proposed for this prediction task. Four benchmark machine learning models, logistic regression (LR), random forest (RF), gradient boosting decision tree (GBDT) and a published cutting edge MMDL, were used to compare and evaluate the models with a fivefold cross-validation approach. Accuracy, recall, area under the ROC curve (AUC), and average precision (AP) were used to evaluate the discrimination of each model at three time points (24 h, 48 h and 72 h) before CADVT occurred. Brier score and Spiegelhalter's z test were used measure the calibration of these prediction models. RESULTS A total of 1830 patients were included in this study, and approximately 15% developed CADVT. In the CADVT prediction task, the model proposed in this paper significantly outperforms both traditional machine learning models and existing multimodal deep learning models at all 3 time points. It achieved 77% accuracy and 90% recall at 24 h before CADVT was discovered. It can be used to accurately predict the occurrence of CADVT 72 h in advance with an accuracy of greater than 75%, a recall of more than 87%, and an AUC value of 0.82. CONCLUSION In this study, a machine learning method was successfully established to predict CADVT in advance. These findings demonstrate that artificial intelligence (AI) could provide measures for thromboprophylaxis in a pediatric intensive care setting.
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Affiliation(s)
- Haomin Li
- Clinical Data Center, The Children's Hospital, Zhejiang University School of Medicine and National Clinical Research Center for Child Health, 3333 Binsheng Road, Hangzhou, 310052, China.
| | - Yang Lu
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Xian Zeng
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Cangcang Fu
- Clinical Data Center, The Children's Hospital, Zhejiang University School of Medicine and National Clinical Research Center for Child Health, 3333 Binsheng Road, Hangzhou, 310052, China
| | - Huilong Duan
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Qiang Shu
- Heart Center, The Children's Hospital, Zhejiang University School of Medicine and National Clinical Research Center for Child Health, 3333 Binsheng Road, Hangzhou, 310052, China.
| | - Jihua Zhu
- Department of Nursing, The Children's Hospital, Zhejiang University School of Medicine and National Clinical Research Center for Child Health, 3333 Binsheng Road, Hangzhou, 310052, China.
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Xiong ZY, Zhou HM, Li SY. Prolonged flushing and locking interval for totally implantable vascular access device: A systematic review and meta-analysis. J Vasc Access 2021; 22:969-978. [PMID: 33752495 DOI: 10.1177/11297298211003003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The objective of this systematic review is to evaluate the safety ad feasibility of the totally implantable vascular access devices (TIVADs) flushed more than 4 weeks. We searched the following electronic databases from the date their build-up to February 2020: PubMed, EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL. The final selection resulted in 14 trials fulfilling the inclusion criteria and being included in our review. A pooled frequency of port-related late complications with longer flushing intervals (>4 weeks) was 8.0%, and the pooled frequency of occlusions, infections, and mechanical complications was 5.0%, 2.0%, and 3.0%, respectively. Then, we compared the frequency of port-related complications between standard and longer flushing intervals. There were no differences between the group's changes in the frequency of total late complications, occlusions, infections, and mechanical complications. This systematic review and meta-analysis demonstrates that longer flushing intervals for ports are safe. However, more prospective, power appropriated randomized trials are needed to explore the specific flushing time for ports.
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Affiliation(s)
- Zhao-Yu Xiong
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui-Min Zhou
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Su-Yun Li
- Department of Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Dieckmann KP, Marghawal D, Pichlmeier U, Wülfing C. Thromboembolic Events in Patients with Testicular Germ Cell Tumours Are Predominantly Triggered by Advanced Disease and by Central Venous Access Systems. Urol Int 2020; 105:257-263. [PMID: 33333524 DOI: 10.1159/000512055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/04/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Thromboembolic events (TEEs) may significantly complicate the clinical management of patients with testicular germ cell tumours (GCTs). We analysed a cohort of GCT patients for the occurrence of TEEs and looked to possible pathogenetic factors. PATIENTS, METHODS TEEs occurring within 6 months after diagnosis were retrospectively analysed in 317 consecutive patients with testicular GCT (median age 37 years, 198 seminoma, 119 nonseminoma). The following factors were analysed for association with TEE: histology, age, clinical stage (CS), chemotherapy, use of a central venous access device (CVA). Data analysis involved descriptive statistical methods with multivariable analysis to identify independent risk factors. RESULTS Twenty-three TEEs (7.3%) were observed, 18 deep vein thromboses, 4 pulmonary embolisms, and 1 myocardial infarction. Univariable risk calculation yielded the following odds ratios (ORs) : >CS1 OR = 43.7 (95% confidence intervals [CIs] 9.9-191.6); chemotherapy OR = 7.8 (95% CI 2.3-26.6); CVA OR = 30.5 (95% CI 11.0-84.3). Multivariable analysis identified only CS > 1 (OR = 16.9; 95% CI 3.5-82.4) and CVA (OR = 9.0; 95% CI 2.9-27.5) as independent risk factors. CONCLUSIONS Patients with CSs >CS1 are at significantly increased risk of TEEs even without chemotherapy. Particular high risk is associated with the use of CVA devices for chemotherapy. Caregivers of GCT patients must be aware of the particular risk of TEEs.
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Affiliation(s)
| | - David Marghawal
- Asklepios Klinik Altona, Urologische Abteilung, Hamburg, Germany
| | - Uwe Pichlmeier
- Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Eppendorf, Hamburg, Zentrum für Experimentelle Medizin, Hamburg, Germany
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Jiang M, Li CL, Pan CQ, Cui XW, Dietrich CF. Risk of venous thromboembolism associated with totally implantable venous access ports in cancer patients: A systematic review and meta-analysis. J Thromb Haemost 2020; 18:2253-2273. [PMID: 32479699 DOI: 10.1111/jth.14930] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/07/2020] [Accepted: 05/19/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Totally implantable venous access ports (TIVAPs) for chemotherapy are associated with venous thromboembolism (VTE). We aimed to quantify the incidence of TIVAP-associated VTE and compare it with external central venous catheters (CVCs) in cancer patients through a meta-analysis. METHODS Studies reporting on VTE risk associated with TIVAP were retrieved from medical literature databases. In publications without a comparison group, the pooled incidence of TIVAP-related VTE was calculated. For studies comparing TIVAPs with external CVCs, odds ratios (ORs) were calculated to assess the risk of VTE. RESULTS In total, 80 studies (11 with a comparison group and 69 without) including 39 148 patients were retrieved. In the noncomparison studies, the overall symptomatic VTE incidence was 2.76% (95% confidence interval [CI]: 2.24-3.28), and 0.08 (95 CI: 0.06-0.10) per 1000 catheter-days. This risk was highest when TIVAPs were inserted via the upper-extremity vein (3.54%, 95% CI: 2.94-4.76). Our meta-analysis of the case-control studies showed that TIVAPs were associated with a decreased risk of VTE compared with peripherally inserted central catheters (OR = 0.20, 95% CI: 0.09-0.43), and a trend for lower VTE risk compared with Hickman catheters (OR = 0.75, 95% CI: 0.37-1.50). Meta-regression models suggested that regional difference may significantly impact on the incidence of VTE associated with TIVAPs. CONCLUSIONS Current evidence suggests that the cancer patients with TIVAP are less likely to develop VTE compared with external CVCs. This should be considered when choosing the indwelling intravenous device for chemotherapy. However, more attention should be paid when choosing upper-extremity veins as the insertion site.
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Affiliation(s)
- Meng Jiang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chang-Li Li
- Department of Geratology, Hubei Provincial Hospital of Integrated Chinese and Western medicine, Wuhan, Hubei Province, China
| | - Chun-Qiu Pan
- Department of Emergency Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Central venous catheter-related thrombosis in children and adults. Thromb Res 2020; 187:103-112. [DOI: 10.1016/j.thromres.2020.01.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/03/2020] [Accepted: 01/14/2020] [Indexed: 02/06/2023]
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Comparison between Arm Port and Chest Port for Optimal Vascular Access Port in Patients with Breast Cancer: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9082924. [PMID: 32104708 PMCID: PMC7040392 DOI: 10.1155/2020/9082924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/15/2019] [Indexed: 12/14/2022]
Abstract
Objectives This meta-analysis was conducted to compare the complication rates between arm and chest ports in patients with breast cancer. Design and Data Sources. PubMed, Embase, Cochrane library, Chinese National Knowledge Infrastructure (CNKI), and Wanfang database were used to perform a systematic review and meta-analysis of publications published from the inception of the database to 11, October 2019. Our search generated a total of 22 articles published from 2011 to 2019, including 6 comparative studies and 16 single-arm articles, involving 4131 cases and 5272 controls. Single-arm studies combined with comparative studies were also pooled and analyzed. Finally, subgroup analysis was performed to compare the rates of infection and thrombosis between these two ports. Eligibility Criteria. Included articles were research studies comparing complication rates of arm ports with chest ports in patients with breast cancer. Any review or meta-analysis article would be removed. Data Extraction and Synthesis. Demographic data and information for the following analysis were extracted. DerSimonian and Laird random effect meta-analysis was conducted to analyze comparative studies while Begg's and Egger's tests were used for assessment of publication bias. Meta-regression analysis was performed to explain the sources of heterogeneity. Results There was no difference in the risk of overall complications between arm and chest ports for comparative studies (P=0.083). While results of pooled comparative and single-arm studies indicated that arm port would increase the overall complication risks with RR of 2.64, results of the subgroup analysis showed that there was no difference in the risk of catheter-related infection between these two ports. However, arm port might be associated with the higher thrombosis rates compared with chest port according to the results of the analysis for only comparative studies (RR of 2.64, results of the subgroup analysis showed that there was no difference in the risk of catheter-related infection between these two ports. However, arm port might be associated with the higher thrombosis rates compared with chest port according to the results of the analysis for only comparative studies (P=0.083). While results of pooled comparative and single-arm studies indicated that arm port would increase the overall complication risks with RR of 2.64, results of the subgroup analysis showed that there was no difference in the risk of catheter-related infection between these two ports. However, arm port might be associated with the higher thrombosis rates compared with chest port according to the results of the analysis for only comparative studies (P=0.083). While results of pooled comparative and single-arm studies indicated that arm port would increase the overall complication risks with. Conclusions This study indicated that the arm port might increase the risk of overall complication risks as well as the risk of catheter-related thrombosis compared with the chest port. However, these reported findings still need to be verified by large randomized clinical trials.
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Clemons M, Stober C, Kehoe A, Bedard D, MacDonald F, Brunet MC, Saunders D, Vandermeer L, Mazzarello S, Awan A, Basulaiman B, Robinson A, Mallick R, Hutton B, Fergusson D. A randomized trial comparing vascular access strategies for patients receiving chemotherapy with trastuzumab for early-stage breast cancer. Support Care Cancer 2020; 28:4891-4899. [PMID: 32002617 DOI: 10.1007/s00520-020-05326-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/23/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Trastuzumab-based chemotherapy is usually administered through either a peripherally inserted central catheter (PICC) or a totally implanted vascular access device (PORT). As the most effective type of access is unknown, a feasibility trial, prior to conducting a large pragmatic trial, was undertaken. METHODS The trial methodology utilized the integrated consent model incorporating oral consent. Patients receiving trastuzumab-based neo/adjuvant chemotherapy for early-stage breast cancer were randomized to a PICC or PORT insertion. Feasibility was reflected through a combination of endpoints; however, the a priori definition of feasibility was > 25% of patients approached agreed to randomization and > 25% of physicians approached patients. Secondary outcomes included rates of line-associated complications such as thrombotic events requiring anticoagulation, line infections or phlebitis. RESULTS During the study period, 4/15 (26.7%) medical oncologists approached patients about study participation. Of 59 patients approached, 56 (94.9%) agreed to randomization, 29 (51.8%) were randomized to PICC and 27 (48.2%) to PORT access. Overall, 17.2% (5/29) and 14.8% (4/27) of patients had at least one line-associated complication in the PICC and PORT arms respectively. The study was terminated early due to slow accrual. CONCLUSION The study met its feasibility endpoints with respect to patient and physician engagement. However, the slow rate of accrual (56 patients in 2 years) means that conducting a large pragmatic trial would require additional strategies to make such a study possible. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02632435.
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Affiliation(s)
- Mark Clemons
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, Canada. .,Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Canada. .,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Carol Stober
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Anne Kehoe
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
| | - Debbie Bedard
- Department of Nursing, Ottawa General Hospital, Ottawa, Canada
| | - Fiona MacDonald
- Department of Nursing, Ottawa General Hospital, Ottawa, Canada
| | | | - Deanna Saunders
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Lisa Vandermeer
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sasha Mazzarello
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Arif Awan
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
| | - Bassam Basulaiman
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
| | - Andrew Robinson
- Division of Medical Oncology, Cancer Centre of Southeastern Ontario, Kingston, Canada
| | | | - Brian Hutton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Dean Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada
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Robinson A, Stober C, Fergusson D, Kehoe A, Bedard D, MacDonald F, Brunet MC, Saunders D, Mazzarello S, Vandermeer L, Joy AA, Awan A, Basulaiman B, Mallick R, Hutton B, Clemons M. A multicentre, randomized pilot trial comparing vascular access strategies for early stage breast cancer patients receiving non-trastuzumab containing chemotherapy. Breast Cancer Res Treat 2019; 178:337-345. [DOI: 10.1007/s10549-019-05388-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 07/31/2019] [Indexed: 11/28/2022]
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12
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Skelton WP, Franke AJ, Welniak S, Bosse RC, Ayoub F, Murphy M, Starr JS. Investigation of Complications Following Port Insertion in a Cancer Patient Population: A Retrospective Analysis. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2019; 13:1179554919844770. [PMID: 31040735 PMCID: PMC6482646 DOI: 10.1177/1179554919844770] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 03/27/2019] [Indexed: 11/24/2022]
Abstract
Central venous access devices, specifically implantable ports, play an essential role in the care of oncology patients; however, complications are prevalent. This retrospective single-institutional review was performed to identify rates of complications from port placement and potential factors associated with these events. A retrospective analysis of 539 cancer patients who underwent port insertion between March 2016 and March 2017 at our institution was conducted. Data examining 18 potentially predictive factors were collected, and multivariate analysis was conducted using logistic regression and odds ratios (ORs) with standard errors to determine predictive factors. Out of 539 patients, 100 patients (19%) experienced 1 complication, and 12 patients (2%) experienced 2 or more complications. An overall lower rate of complications was seen in patients on therapeutic anticoagulation (OR: 0.17, P < .001) or on antiplatelet agents (OR: 0.47, P = .02). No patients on therapeutic anticoagulation developed venous thromboembolism (VTE; 0%). Right-sided port insertion was associated with decreased rates of infection (OR: 0.44, P = .04). Insertion as inpatient was associated with an increased risk for mechanical failure (OR: 4.60, P < .01). This analysis identified multiple predictive factors that can potentially put patients at a higher risk of experiencing complications following port insertion. Our data show lower rates of VTE for patients on anticoagulation or antiplatelet therapy. Further analysis is also necessary to determine why port insertion as an inpatient places patients at a higher risk of complications. This study highlights the risks associated with port placement and prompts the clinician to have an informed discussion with the patient weighing the risks and benefits.
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Affiliation(s)
- William Paul Skelton
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Aaron J Franke
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Samantha Welniak
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Raphael C Bosse
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Fares Ayoub
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Martina Murphy
- Division of Hematology & Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jason S Starr
- Division of Hematology & Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
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13
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Implanted vascular access device related deep vein thrombosis in oncology patients: A prospective cohort study. Thromb Res 2019; 177:117-121. [DOI: 10.1016/j.thromres.2019.02.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 02/17/2019] [Accepted: 02/28/2019] [Indexed: 01/13/2023]
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Cancer-associated thrombosis in patients with implanted ports: a prospective multicenter French cohort study (ONCOCIP). Blood 2018; 132:707-716. [DOI: 10.1182/blood-2018-03-837153] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 07/02/2018] [Indexed: 12/21/2022] Open
Abstract
Key PointsThe incidence of venous thromboembolism is high in patients with a solid tumor and implanted port in the real-life practice setting. The risk factors for catheter-related thrombosis differ from those for venous thromboembolism unrelated to the catheter.
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15
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LeVasseur N, Stober C, Daigle K, Robinson A, McDiarmid S, Mazzarello S, Hutton B, Joy A, Fergusson D, Hilton J, McInnes M, Clemons M. Optimizing vascular access for patients receiving intravenous systemic therapy for early-stage breast cancer-a survey of oncology nurses and physicians. Curr Oncol 2018; 25:e298-e304. [PMID: 30111975 PMCID: PMC6092058 DOI: 10.3747/co.25.3903] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Despite advances in systemic therapy choices for patients with early-stage breast cancer, optimal practices for intravenous (IV) access remain unknown. That lack of knowledge holds particularly true for the use of central venous access devices (cvads) such as peripherally inserted central catheters (piccs) and implanted vascular access devices (ports). Methods Using a survey of Canadian oncologists and oncology nurses responsible for the care of breast cancer patients, we evaluated current access practices, perceptions of complications, and perceptions of risk, and we estimated complication rates and evaluated perceived risk factors for lymphedema. Results Survey responses were received from 25 physicians and 57 oncology nurses. Administration of trastuzumab or an anthracycline was associated with a higher likelihood of a cvad being recommended. Other factors associated with recommendation of a cvad included prior difficult IV access and a recommendation from the chemotherapy nurse. Although the complication rates perceived to be associated with the use of piccs and ports remained high, respondents felt that cvads might improve patient quality of life. Risk factors perceived to be associated with the risk of lymphedema were axillary lymph node dissection, radiation to the axilla, and line-associated infection. Factors known to be unrelated to lymphedema risk (specifically, blood draws and blood pressure measurement) continue to be perceived as posing a higher risk. Conclusions Despite widespread use of chemotherapy for patients with breast cancer, the type of venous access used for treatment varies significantly, as do perceptions about the risks of cvad use and the risk for lymphedema development. Further prospective studies are needed to identify best-practice strategies.
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Affiliation(s)
- N. LeVasseur
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa
| | - C. Stober
- The Ottawa Hospital Research Institute, Ottawa
| | - K. Daigle
- Department of Nursing, The Ottawa Hospital, Ottawa
| | - A. Robinson
- Division of Medical Oncology, Cancer Centre of Southeastern Ontario, Kingston; and
| | - S. McDiarmid
- Department of Nursing, The Ottawa Hospital, Ottawa
| | | | - B. Hutton
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - A. Joy
- Department of Oncology, Division of Medical Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB
| | - D. Fergusson
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - J. Hilton
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa
- The Ottawa Hospital Research Institute, Ottawa
| | - M. McInnes
- Department of Radiology, The Ottawa Hospital, Ottawa, ON
| | - M. Clemons
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa
- The Ottawa Hospital Research Institute, Ottawa
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
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16
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Tippit D, Siegel E, Ochoa D, Pennisi A, Hill E, Merrill A, Rowe M, Henry-Tillman R, Ananthula A, Makhoul I. Upper-Extremity Deep Vein Thrombosis in Patients With Breast Cancer With Chest Versus Arm Central Venous Port Catheters. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2018; 12:1178223418771909. [PMID: 29881287 PMCID: PMC5987887 DOI: 10.1177/1178223418771909] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 03/29/2018] [Indexed: 12/31/2022]
Abstract
Most of the patients undergoing treatment for cancer require placement of a
totally implantable venous access device to facilitate safe delivery of
chemotherapy. However, implantable ports also increase the risk of deep vein
thrombosis and related complications in this high-risk population. The objective
of this study was to assess the incidence of upper-extremity deep vein
thrombosis (UEDVT) in patients with breast cancer to determine whether the risk
of UEDVT was higher with chest versus arm ports, as well as to determine the
importance of previously reported risk factors predisposing to UEDVT in the
setting of active cancer. We retrospectively reviewed the medical records of 297
women with breast cancer who had ports placed in our institution between the
dates of December 1, 2010, and December 31, 2016. The primary outcome was the
development of radiologically confirmed UEDVT ipsilateral to the implanted port.
Overall, 17 of 297 study subjects (5.7%) were found to have UEDVT. There was 1
documented case of associated pulmonary embolism. Fourteen (9.5%) of 147
subjects with arm ports experienced UEDVT compared with only 3 (2.0%) of 150
subjects with chest ports (P = .0056). Thus, implantation of
arm ports as opposed to chest ports may be associated with a higher rate of
UEDVT in patients with breast cancer.
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Affiliation(s)
- Danielle Tippit
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Eric Siegel
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Daniella Ochoa
- Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Angela Pennisi
- Division of Medical Oncology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Erica Hill
- Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Amelia Merrill
- Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mark Rowe
- Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ronda Henry-Tillman
- Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Aneesha Ananthula
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Issam Makhoul
- Division of Medical Oncology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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17
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Makary MS, Lionberg A, Khayat M, Lustberg MB, AlTaani J, Pan XJ, Layman RR, Raman SV, Layman RM, Dowell JD. Advanced stage breast cancer is associated with catheter-tip thrombus formation following implantable central venous port placement. Phlebology 2018; 34:107-114. [PMID: 29771187 DOI: 10.1177/0268355518774442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE Catheter-tip associated thrombosis is not uncommon in patients with implantable central venous ports; however, the prevalence and clinical impact of this complication on patient management is unclear. This study aims to identify risk factors for thrombus formation in a large population receiving serial echocardiograms (echo) following port placement. METHODS A total of 396 female breast cancer patients underwent internal jugular vein chest port placement between 2007 and 2013 and received echo studies every third month. Catheter tip position was measured from chest radiography and catheter associated thrombus was identified by echo. RESULTS Sixteen out of 396 patients (4%) had catheter-tip thrombus. No patients were symptomatic or prophylactically anticoagulated. Patients with thrombus were significantly younger than those without (46.4 years versus 53.4 years, respectively, p = 0.02) and had higher stage breast cancer with 75% versus 44.7% having stage III or IV cancer ( p = 0.017). Thrombus was identified after a median of 91 days. No significant difference was identified in anatomic ( p = 0.1) or measured ( p = 0.15) tip position, port laterality ( p = 0.86), or number of port lumens ( p = 0.65). CONCLUSIONS In this large cohort, younger patients and those with more advanced stage breast cancer were more associated with catheter-tip-related thrombus after port placement.
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Affiliation(s)
- Mina S Makary
- 1 Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alexander Lionberg
- 2 Department of Radiology, University of Chicago Medical Center, Chicago, IL, USA
| | - Mamdouh Khayat
- 3 Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Maryam B Lustberg
- 4 Division of Medical Oncology, Department of Internal Medicine, The James Cancer Hospital and Richard Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Jamal AlTaani
- 1 Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Xueliang J Pan
- 5 Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Richard R Layman
- 6 Division of Diagnostic Imaging, Department of Imaging Physics, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Subha V Raman
- 7 Division of Cardiovascular Medicine, Department of Internal Medicine, Richard R. Ross Heart Hospital and Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rachel M Layman
- 8 Department of Breast Medical Oncology, Division of Cancer Medicine, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Joshua D Dowell
- 1 Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,9 Northwest Radiology, St. Vincent Health, Indianapolis, IN, USA
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18
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Nañez-Terreros H, Jaime-Perez JC, Muñoz-Espinoza LE, Camara-Lemaroy CR, Ornelas-Cortinas GE, Ramos-Dena RD, Gonzalez-Guerrero JF, Nangullasmu-Plasencia T, Gonzalez-Escamilla M, Chipuli-Lopez O. D-dimer from central and peripheral blood samples in asymptomatic central venous catheter-related thrombosis in patients with cancer. Phlebology 2018; 34:52-57. [DOI: 10.1177/0268355518772171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To evaluate the usefulness of a negative D-dimer in peripheral or central venous blood to screen for asymptomatic catheter-related thrombosis in cancer patients. Methods D-dimer was measured in blood from central venous catheter and peripheral venous samples in 48 patients with cancer. Asymptomatic catheter-related thrombosis was identified via Doppler ultrasound. Bland and Altman’s limits of agreement analysis was used to compare sample sites. Sensitivity and specificity of D-dimer was calculated. Results Overall, 33 of the central samples and 32 of the peripheral samples had D-dimer levels below the cutoff (≥0.3 mg/l). Mean central D-dimer was 0.31 ± 0.35 mg/l; peripheral 0.24 ± 0.22 mg/l (p = 0.5). Bland–Altman plot showed that the two sample sites were not equivalent. Catheter-related thrombosis was demonstrated in five patients, and there were three false negatives. Peripheral D-dimer had a negative predictive value of 90.9%. Conclusions A negative D-dimer may be useful for screening asymptomatic catheter-related thrombosis in patients with cancer, but the central and peripheral sample sites are not equivalent.
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Affiliation(s)
- Homero Nañez-Terreros
- Internal Medicine Department Research Team, Faculty of Medicine and Dr. Jose E. Gonzalez University Hospital, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Jose C Jaime-Perez
- Hemathology Service, Faculty of Medicine and Dr. Jose E. Gonzalez University Hospital, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Linda E Muñoz-Espinoza
- Internal Medicine Department Research Team, Faculty of Medicine and Dr. Jose E. Gonzalez University Hospital, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Carlos R Camara-Lemaroy
- Internal Medicine Department Research Team, Faculty of Medicine and Dr. Jose E. Gonzalez University Hospital, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Gerardo E Ornelas-Cortinas
- Radiology Department, Faculty of Medicine and Dr. Jose E. Gonzalez University Hospital, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Ricardo D Ramos-Dena
- Radiology Department, Faculty of Medicine and Dr. Jose E. Gonzalez University Hospital, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Juan F Gonzalez-Guerrero
- Oncology and Radiotherapy Department, Faculty of Medicine and Dr. Jose E. Gonzalez University Hospital, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Tomas Nangullasmu-Plasencia
- Internal Medicine Department Research Team, Faculty of Medicine and Dr. Jose E. Gonzalez University Hospital, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Moises Gonzalez-Escamilla
- Oncology and Radiotherapy Department, Faculty of Medicine and Dr. Jose E. Gonzalez University Hospital, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Osvaldo Chipuli-Lopez
- Internal Medicine Department Research Team, Faculty of Medicine and Dr. Jose E. Gonzalez University Hospital, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
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Safety and Feasibility of Temporary Superior Vena Cava Filter Combined with Balloon Dilatation and Catheter-Directed Thrombolysis for Catheter-Related Thrombosis. Ann Vasc Surg 2018; 47:69-77. [DOI: 10.1016/j.avsg.2017.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 08/01/2017] [Accepted: 08/25/2017] [Indexed: 11/20/2022]
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20
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Widick P, Brunner AM, Schiffman F. Hematologic Manifestations of Malignancy. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00155-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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21
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Baumann Kreuziger L, Jaffray J, Carrier M. Epidemiology, diagnosis, prevention and treatment of catheter-related thrombosis in children and adults. Thromb Res 2017; 157:64-71. [DOI: 10.1016/j.thromres.2017.07.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 06/09/2017] [Accepted: 07/03/2017] [Indexed: 12/21/2022]
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22
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Peripherally inserted central catheter-related complications in cancer patients: a prospective study of over 50,000 catheter days. J Vasc Access 2017; 18:153-157. [PMID: 28218366 DOI: 10.5301/jva.5000670] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 12/13/2022] Open
Abstract
Purpose To evaluate incidence and risk factors of peripherally inserted central catheter (PICC)-related complications in cancer patients. Methods A prospective, multicenter, cohort study of cancer patients with PICC insertion was performed from February 1, 2013 to April 24, 2014. All patients were monitored in clinic until PICCs were removed. The primary endpoint was PICC removal due to complications. Patient-, catheter- and insertion-related factors were analyzed in univariable and multivariable logistic regression analysis to identify significant independent risk factors for PICC-related complications. Results There were 477 cancer patients included, for a total of 50,841 catheter-days. Eighty-one patients (17.0%) developed PICC-related complications, with an incidence of 1.59 per 1000 catheter days. Thirty-six (7.5%) PICCs were removed because of complications. The most common complications were skin allergy (4.6%), catheter occlusion (3.4%) and accidental withdrawal (2.3%). Nine (1.9%) patients developed symptomatic upper extremity deep venous thrombosis (UEDVT) and central line associated bloodstream infection (CLABSI) was shown in six (1.3%) PICCs with an infection rate 0.12 per 1000 catheter days. In multivariable analysis, body mass index (BMI) >25 (odds ratio, 2.09; 95% confidence interval, 1.26-3.47, p = 0.004) was shown to be a significant risk factor for PICC complications. Conclusions Cancer patients with BMI greater than 25 were more likely to have PICC complications.
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23
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Voog E, Campion L, du Rusquec P, Bourgeois H, Domont J, Denis F, Emmanuel E, Dupuis O, Ganem G, Lafont C, Le Du K, Pavluc E, Pointreau Y, Roche S, Juhel-Voog L, Zinger M, Solal-Celigny P. Totally implantable venous access ports: a prospective long-term study of early and late complications in adult patients with cancer. Support Care Cancer 2017; 26:81-89. [DOI: 10.1007/s00520-017-3816-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 07/03/2017] [Indexed: 11/28/2022]
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24
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Health-Related Quality of Life of Cancer Patients with Peripherally Inserted Central Catheter: A Pilot Study. J Vasc Access 2017; 18:396-401. [PMID: 28777395 DOI: 10.5301/jva.5000762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction This pilot exploratory study aimed to compare the health-related quality of life (HRQOL) among patients diagnosed with different types of cancer receiving peripherally inserted central catheters (PICCs). Methods A multicenter cross-section study of cancer patients with PICCs was performed from February 1, 2013 to April 24, 2014. The primary objective of this study was to compare HRQOL in different cancer type patients with PICC. HRQOL was examined based on European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire-Core 30 (EORTC QLQ-C30). Multiple linear regression models were conducted for coping with potential confounding variables. We also examined PICC-related quality of daily life with a self-made questionnaire. Results Three hundred and fifty-seven cancer patients with PICC completed the survey in nine teaching hospitals. Lung cancer patients with PICC reported the worst dyspnea. Digestive tract cancer patients reported the worst appetite loss. Patients with hematologic malignancy reported the worst emotional, social function, fatigue and financial impact. Breast cancer patients reported better HRQOL. Baseline variables were proven not significant predictors of EORTC QLQ-C30 global health status. In self-made survey, pain after PICC insertion was null or a little in 98.6% of cancer patients. Limitation of upper extremity activity was null or a little in 94.1% of patients. Conclusions HRQOL varies in different types of cancer patients with PICC. PICC may have a low impact on cancer patients’ HRQOL. Further large sample studies are needed.
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25
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Abstract
Deep vein thrombosis of the leg and pulmonary embolism are frequent diseases and cancer is one of their most important risk factors. Patients with cancer also have a higher prevalence of venous thrombosis located in other parts than in the legs and/or in unusual sites including upper extremity, splanchnic or cerebral veins. Cancer also affects the risk of arterial thrombotic events particularly in patients with myeloproliferative neoplasms and in vascular endothelial growth factor receptor inhibitor recipients. Several risk factors need to interact to trigger thrombosis. In addition to common risk factors such as surgery, hospitalisation, infection and genetic coagulation disorders, the thrombotic risk is also driven and modified by cancer-specific factors including type, histology, and stage of the malignancy, cancer treatment and certain biomarkers. A venous thrombotic event in a cancer patient has serious consequences as the risk of recurrent thrombosis, the risk of bleeding during anticoagulation and hospitalisation rates are all increased. Survival of cancer patients with thrombosis is worse compared to that of cancer patients without thrombosis, and thrombosis is a leading direct cause of death in cancer patients.
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Affiliation(s)
- Sabine Eichinger
- Department of Internal Medicine I, Medical University of Vienna; Karl Landsteiner Institute of Thrombosis Research, Vienna, Austria.
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26
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Dridi M, Mejri N, Labidi S, Afrit M, Benna HE, Miled KB, Boussen H. Implantable port thrombosis in cancer patients: a monocentric experience. Cancer Biol Med 2016; 13:384-388. [PMID: 27807505 PMCID: PMC5069832 DOI: 10.20892/j.issn.2095-3941.2016.0057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective: Implantable port thrombosis (IPT) in cancer patients is a relatively rare but severe complication. Several factors are reportedly associated with the occurrence of thrombosis. We aimed to describe the prevalence and the anatomoclinical features of IPT observed in cancer patients who were treated in a medical oncology department in Tunisia. Methods: A total of 600 cancer patients who had port implantation from January 2013 to December 2015 were retrospectively identified. Cases with symptomatic/incidental IPT (radiologically confirmed) were further identified. Epidemiological and anatomoclinical features were collected from patient records and the department database. Results: We observed that 33 of the 600 patients had IPT; thus, the prevalence was 5.5%. The median age was 57 years, and the gender ratio was 0.43. Overweight or obesity was observed in 73% of the patients. IPT occurred mainly in patients with breast (36.4%) and colorectal (33.3%) cancers, which were mostly nonmetastatic (79%). At least one identified classical thromboembolic risk factor was found in 13 patients (smoking in 9, tamoxifen in 2). IPT was symptomatic in 93% of the cases, occurring within an average time of 56 days. Implantable ports were removed because of infection in 2 cases and nonfunctionality in 3 cases. IPT treatment was based on low-molecular-weight heparins (94%) and antivitamin K (6%) for an average of 130 days. Four patients had post-therapy complications: one thrombosis recurrence and three infections. Conclusions: IPT cases in the 600 patients were observed to occur in obese nonmetastatic cancer patients within the first 3 months after IP implantation.
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Affiliation(s)
- Manel Dridi
- Medical Oncology Department, Abderrahmen Mami Hospital, Ariana 2080, Tunisia
| | - Nesrine Mejri
- Medical Oncology Department, Abderrahmen Mami Hospital, Ariana 2080, Tunisia
| | - Soumaya Labidi
- Medical Oncology Department, Abderrahmen Mami Hospital, Ariana 2080, Tunisia
| | - Mehdi Afrit
- Medical Oncology Department, Abderrahmen Mami Hospital, Ariana 2080, Tunisia
| | - Houda El Benna
- Medical Oncology Department, Abderrahmen Mami Hospital, Ariana 2080, Tunisia
| | - Khaoula Ben Miled
- Radiology Department, Abderrahmen Mami Hospital, Ariana 2080, Tunisia
| | - Hamouda Boussen
- Medical Oncology Department, Abderrahmen Mami Hospital, Ariana 2080, Tunisia
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27
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Kang JR, Long LH, Yan SW, Wei WW, Jun HZ, Chen W. Peripherally Inserted Central Catheter-Related Vein Thrombosis in Patients With Lung Cancer. Clin Appl Thromb Hemost 2016. [PMID: 26207019 DOI: 10.1177/1076029615595880] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Peripherally inserted central venous catheters (PICCs) are widely used in patients with cancer. Catheter usage is one of the risk factors for venous thromboembolism. We aimed to scrutinize the incidence and risk factors for PICC-related upper extremity venous thrombosis (UEVT) in patients with lung cancer receiving chemotherapy. Patients and Methods: We performed a retrospective cohort study of patients with lung cancer with PICC insertion undergoing chemotherapy. Symptomatic PICC-UEVT was diagnosed by ultrasound. The relationship between chemotherapeutic agent exposure and PICC-UEVT was evaluated. Patient-, catheter-, and insertion-related factors were analyzed in univariable and multivariable logistic regression to identify significant independent risk factors for PICC-UEVT in patients with lung cancer. Results: A total of 328 patients with lung cancer having PICC undergoing chemotherapy were included, for a total of 34 895 catheter days. Seventeen (5.2%) patients developed PICC-related UEVT, with an incidence of 0.49 per 1000 catheter days. In multivariable logistic analysis, advanced disease was shown to be a significant risk factor for PICC-UEVT (odds ratio [OR]: 4.9; 95% confidence interval [CI]: 1.4-16.7; P = .011). Patients treated with etoposide had a higher risk of PICC-related UEVT (OR: 3.6; 95% CI: 1.1-12.1; P = .042). Patients were followed up after PICC removal for a median duration of 246 days. None of the patients developed pulmonary embolism. Conclusion: Patients with lung cancer harboring an advanced disease or treating with etoposide were at higher risk of PICC-UEVT.
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Affiliation(s)
- Jun Ren Kang
- Department of Parenteral and Enteral Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Hai Long
- Department of Parenteral and Enteral Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sun Wen Yan
- Department of Parenteral and Enteral Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wang Wei Wei
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy Of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Han Zhi Jun
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy Of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Chen
- Department of Parenteral and Enteral Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Castaman G. Risk of thrombosis in cancer and the role of supportive care (transfusion, catheters, and growth factors). Thromb Res 2016; 140 Suppl 1:S89-92. [DOI: 10.1016/s0049-3848(16)30105-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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29
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Large Cohort Study of Central Venous Catheter Thrombosis during Intravenous Antibiotic Therapy. Antimicrob Agents Chemother 2015; 60:36-43. [PMID: 26459894 DOI: 10.1128/aac.00700-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 09/30/2015] [Indexed: 11/20/2022] Open
Abstract
The frequency and risk factors for central venous catheter-related thrombosis (CRT) during prolonged intravenous (i.v.) antibiotic therapy have rarely been reported. The primary objective of this study was to evaluate the frequency, incidence, and risk factors for CRT among patients being treated with prolonged i.v. antibiotic therapy. The secondary objective was to describe the clinical manifestations, diagnostic evaluation, and clinical management. This cohort study was conducted between August 2004 and May 2010 in a French referral center for osteoarticular infections. All patients treated for bone and joint infections with i.v. antimicrobial therapy through a central venous catheter (CVC) for ≥2 weeks were included. Risk factors were identified using nonparametric tests and logistic regression. A case-control study investigated the role of vancomycin and catheter malposition. A total of 892 patients matched the inclusion criteria. CRT developed in 16 infections occurring in 16 patients (incidence, 0.39/1,000 catheter days). The median time to a CRT was 29 days (range, 12 to 48 days). Local clinical signs, fever, and secondary complications of CRT were present in 15, 8, and 4 patients, respectively. The median C-reactive protein level was 95 mg/liter. The treatment combined catheter removal and a median of 3 months (1.5 to 6 months) of anticoagulation therapy. The outcome was good in all patients, with no recurrence of CRT. Three risk factors were identified by multivariate analysis: male sex (odds ratio [OR], 5.4; 95% confidence interval [CI], 1.1 to 26.6), catheter malposition (OR, 5.3; 95% CI, 1.6 to 17.9), and use of vancomycin (OR, 22.9; 95% CI, 2.8 to 188). Catheter-related thrombosis is a rare but severe complication in patients treated with prolonged antimicrobial therapy. Vancomycin use was the most important risk factor identified.
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Peripherally Inserted Central Catheter-Related Vein Thrombosis in Breast Cancer Patients. J Vasc Access 2015; 17:67-71. [PMID: 26349890 DOI: 10.5301/jva.5000457] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2015] [Indexed: 12/13/2022] Open
Abstract
Purpose To identify clinical incidence, risk factors and treatment of peripherally inserted central venous catheters (PICCs)-related upper extremity venous thrombosis (UEVT) in breast cancer patients undergoing chemotherapy. Methods We performed a retrospective cohort study of breast cancer patients with PICC insertion undergoing chemotherapy. PICC-related UEVT was diagnosed by ultrasound. Patient-, catheter- and insertion-related factors were analyzed in univariable and multivariable logistic regression to identify significant independent risk factors for PICC-related UEVT. The incidence and treatment of PICC-related UEVT were also analyzed. Results A total of 568 breast cancer patients with PICC undergoing chemotherapy were included, for a total of 54,769 catheter days; 8 patients (1.4%) developed PICC-related UEVT. The median time of developing UEVT was 11 days (range of 3 to 79 days). In multivariable analysis, metastasis (p = 0.002) and malposition (p = 0.013) were shown to be significant risk factors for PICC-related UEVT. All patients were treated with low-molecular-weight heparin (LMWH) and followed until PICCs were removed. None of the patients developed pulmonary embolus. Conclusions Metastasis and malposition were significant risk factors for PICC-related UEVT in breast cancer patients. With early diagnosis and standardized anticoagulant treatment, a better clinical outcome could be achieved. Further prospective and large sample studies are needed.
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Abstract
AbstractPurpose: Various venous access devices are available, including peripheral venous lines, peripherally inserted central catheters lines, and subcutaneous port catheters. The latter provides medium-to long-term venous access and includes medical devices that can be inserted either on the chest (chest ports) or in the arm (arm ports). We report the techniques, dedicated indications, and main complications of arm port insertion using the ultrasonography (US) guidance method.Methods: Tips and tricks of percutaneous real-time US-guided vein access technique in the arm are reviewed, and a brief literature review is reported.Results: Technical feasibility is almost 99%. US guidance allows depiction of anatomic variants, reduces the number of failed attempts, and increases the technical access rate compared with venography-guided access. Comparison of arm ports to chest ports reveals a higher global complication rate. We also report typical (mechanical) complications and dedicated indications, including contraindications to chest port insertion and selected patients for whom chest ports are not possible (eg, those with breast, head, and neck cancer; obesity; cosmesis; and requiring upright position).Conclusions: Arm port insertion under US guidance is safe and effective, and has dedicated indications.
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Geerts W. Central venous catheter-related thrombosis. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2014; 2014:306-311. [PMID: 25696870 DOI: 10.1182/asheducation-2014.1.306] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Thrombotic complications associated with the use of central venous catheters (CVCs) are common and lead to distressing patient symptoms, catheter dysfunction, increased risk of infections, long-term central venous stenosis, and considerable costs of care. Risk factors for catheter-related thrombosis include use of larger, multilumen, and peripherally inserted catheters in patients with cancer receiving chemotherapy. Symptomatic catheter-related thrombosis is treated with anticoagulation, generally without removing the catheter. The intensity and duration of anticoagulation depend on the extent of thrombosis, risk of bleeding, and need for continued use of a CVC. To date, the clinical benefit of prophylactic doses of anticoagulant has been disappointing and these agents are not used routinely for this purpose. This chapter focuses on recent evidence, remaining controversies, and practical approaches to reducing the burden of thrombosis associated with CVCs.
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Affiliation(s)
- William Geerts
- Thromboembolism Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Kang JR, Li HL, Chen W. Peripherally inserted central catheter-related deep vein thrombosis: contemporary patterns and predictors: comment. J Thromb Haemost 2014; 12:1943-4. [PMID: 25099554 DOI: 10.1111/jth.12682] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 07/25/2014] [Indexed: 11/30/2022]
Affiliation(s)
- J R Kang
- Department of Parenteral and Enteral Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Jasti N, Streiff MB. Prevention and treatment of thrombosis associated with central venous catheters in cancer patients. Expert Rev Hematol 2014; 7:599-616. [DOI: 10.1586/17474086.2014.954541] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Marcy PY, Thariat J, Lacout A, Sanglier J, Figl A, Chamorey E. Further data about catheter related venous thrombosis in oncology. Thromb Res 2014; 134:207-9. [PMID: 24792955 DOI: 10.1016/j.thromres.2014.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/05/2014] [Accepted: 04/07/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Pierre-Yves Marcy
- Polyclinique Les Fleurs, Service Imagerie Médicale, 332 Avenue Frederic Mistral, 83190 Ollioules.
| | - Juliette Thariat
- Department of Radiation Oncology, Antoine Lacassagne Cancer Research Institute, 33, Avenue Valombrose, 06189 Nice cedex1 France.
| | - Alexis Lacout
- Centre d'imagerie Médicale, 47, Boulevard du Pont Rouge, 15000 Aurillac, France.
| | - Julie Sanglier
- Head&Neck and Interventional Radiology Department, Antoine Lacassagne Cancer Research Institute, 33, Avenue Valombrose, 06189 Nice cedex1 France.
| | - Andrea Figl
- Oncology breast surgery department, Antoine Lacassagne Cancer Research Center, 33 avenue Valombrose, 06189 NICE cedex 1 France.
| | - Emmanuel Chamorey
- Biostatistics Department, Head, Antoine Lacassagne Cancer Research Center, 33 avenue Valombrose, 06189 NICE cedex 1 France.
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