Better lung biopsies to improve diagnosis

At the LCA lung clinical forum on 18 November, Dr Mary Roddie, consultant radiologist at Imperial College Healthcare Trust, presented an update on the guidelines for radiologically guided lung biopsy. These guidelines are intended to help standardise patient preparation for radiologists performing lung biopsies in anyone with suspected lung cancer. A pre-lung biopsy checklist was also issued as well as guidance for taking quality biopsies, aimed at radiologists and pathologists. These will form part of the lung clinical guidelines.

Dr Sam Hare, consultant thoracic radiologist at the Royal Free London NHS Trust, presented a technique that allows ambulatory lung biopsy with early discharge and outpatient management of pneumothorax. Using a Heimlich ‘flutter’ valve it allows for safe home treatment of pneumothorax, whilst being cost effective. It can also be placed intra-biopsy allowing safe biopsy of difficult cases. The LCA will undertake a baseline audit to understand if this technique can be adopted and whether any training is required.

There was also a presentation by Dr Merina Ahmed, clinical oncologist at The Royal Marsden, on radiosurgery guidance for MDTs to aid patient selection and best referral practice. An LCA audit in August 2015 reported a high number of breaches due to treatment delays, therefore the lung forum group agreed to develop an MDT proforma that would help with standardising the treatment information required and streamline the referral process for treatment.

The final presentation focused on the 62 day pathway and straight to CT referrals. Audit data were presented to illustrate where challenges lie and how these can be overcome. A lung 62 day pathway and straight to CT resource pack was issued to attendees to help support trusts. They were asked to review the information locally and provide comments by the end of November.

Presentations from the forum are available here

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