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Major boost for lung cancer diagnosis

Innovative outpatient biopsy delivers 10 times more tests than conventional methods

Mark Gould

Tuesday, 28 June 2016

An innovative method of carrying out lung biopsies developed at a London hospital could free up hundreds of beds and provide faster lung cancer diagnosis. Doctors at Barnet Hospital, part of the Royal Free London NHS Trust, say their new outpatient lung biopsy method can deliver 10 times more potentially life-saving tests each year than conventional methods that require a short hospital stay.

Chest radiologist Dr Sam Hare, who helped develop the procedure, feels it should be shared across the NHS as UK lung cancer patients are not seeing the full benefit of the latest therapies because of delays in diagnosis caused by the sheer amount of time it takes to get someone in for a biopsy.

Dr Hare explains: "I was trained in the UK to perform standard, uncomplicated lung biopsies. This is the pivotal lung cancer diagnostic test and usually involves four to six hours post-biopsy monitoring in a hospital bed, even in routine cases. If a lung biopsy patient developed a pneumothorax, this would usually require a formal in-patient admission and treatment with a traditional bulky chest drain for a few days.

"Today nearly every standard NHS lung biopsy relies on the availability of a hospital bed for at least four to six hours. Furthermore, the prospect of a patient being hospitalised for two to three days with a large, uncomfortable chest drain means that many patients in the UK, typically those who are older or have smaller cancers that are more complicated to biopsy, will often decline – or be declined – a lung biopsy."

Since 2011, Barnet Hospital has performed lung biopsies on an entirely outpatient basis without the need for hospital beds. This not only means that bed-related scheduling delays have been completely eliminated, but the vast majority of patients can be discharged just 30 minutes after their biopsy. Such creative thinking, using methodology with an international evidence-base, has permitted the hospital to perform anywhere between 10 and 14 lung biopsies every week, whereas most hospitals of equivalent size might do only one or two.

Crucially, even if patients develop a pneumothorax, they are treated at home using a discreet, portable device called a Heimlich-valve chest drain (HVCD). The device is small enough to be concealed under the patient’s clothes and allows patients to engage in normal daily activities while it treats their collapsed lung. For some patients this has even included doing the weekly supermarket shop or being able to continue caring for a disabled partner at home.

Dr Hare says that the evidence speaks for itself. "Since 2011 the hospital has performed close to 800 ambulatory lung biopsies and 99% of patients have been discharged within 30 to 60 minutes, including those patients who experienced lung collapse. Thanks to the Heimlich valve, pneumothorax has become a minor inconvenience for our patients, rather than a major upheaval.

"Due to our innovation, Royal Free London patients are being diagnosed more quickly. Correspondingly, more patients are undergoing curative lung cancer surgery and accessing the latest lung cancer treatments."

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