Comparison of chest radiograph and surface measurement to predict cavoatrial junction position of totally implantable venous-access port.

Background: Accurately predicting cavoatrial junction (CAJ) position is important for totally implantable venous-access port (TIVAP) application, which could reduce complications.

Methods: Clinical information of 117 breast cancer (BRCA) patients who underwent TIVAP implantation was collected. The length of the implanted catheter was determined by a chest radiograph method in the test group, as follows: total catheter insertion length was L, and the distance from the pre-puncture point to the right sternoclavicular joint was measured as L1; the distance from the right sternoclavicular joint to 1.5 vertebral bodies under the trachea carina in the chest radiograph was measured as L2; the preset catheter length was L = L1 + L2. The length of the implanted catheter was determined by a surface measurement method in the control group, as follows: total length of catheter insertion was L; the distance from the pre-puncture point to the right sternoclavicular joint was measured as L1; the distance from the third anterior intercostal space of the right sternoclavicular joint was measured on the body surface as L2; the preset catheter length was L = L1 + L2. CAJ positioning rate and complication rate were compared between the two method groups. Logistic regression analysis, receiver operating characteristic, and decision curve analysis were performed to evaluate the predictive value of the chest radiograph.

Results: For BRCA patients, the chest radiograph was exhibited more accurately in predicting CAJ position. Subgroup analysis indicated a remarkably higher CAJ position rate in the chest radiograph method group regardless of age, while no significant difference between the two measurement groups for patients with BMI > 24.9 kg/m² was observed.

Conclusion: The chest radiograph method could more effectively predict the CAJ position than the surface measurement in the overall cohort. However, subgroup analysis revealed that this advantage was not statistically significant in patients with BMI > 24.9 kg/m², suggesting reduced efficacy in high-BMI populations.