Aim To determine if an early discharge radiology-led percutaneous lung biopsy (PLB) service, incorporating ambulatory outpatient small calibre Heimlich valve chest drain (HVCD) to treat pneumothorax, is potentially safe and advantageous to the NHS.
Methods A prospective study of 489 consecutive outpatient image-guided PLBs, performed between March 2011–March 2015, was conducted. Patients were discharged at 30 min if no pneumothorax was present; repeat 60-minute CXR was performed if a small asymptomatic pneumothorax was noted. If stable, patients were discharged. In enlarging or symptomatic pneumothorax, patients were discharged with HVCD in situ and followed up for drain removal. Data on complications was concurrently collected, including pneumothorax rates, numbers of patients requiring HVCD and failed early discharge. A retrospective blinded pulmonary function test (PFT) analysis was also performed at the end of the study period.
Results 489 PLBs were performed with diagnostic accuracy of 97.8%. 402 (82.2%) patients were discharged at 30 min, all without further incident. 87 patients developed pneumothorax (17.8%). 35 patients with a small stable, asymptomatic pneumothorax were discharged at 60 min without complication. 52 patients required HVCD, with 5/52 proceeding to PLB with drain in-situ: 38/52 (73.1%) had drain removal at 24 h and 14/52 (26.9%) at 48 h, with none requiring HVCD greater than 48 h. 4/489 patients were admitted, for social issues.
A blinded retrospective review of PFT data, available in 212/489 patients, revealed 28 with FEV1 <1l. 22/28 (78.6%) were discharged at 30 min without incident; 6/28 patients (21.4%) developed post –PLB pneumothorax with three (10.7%) requiring outpatient HVCD, for 24 h duration.
Conclusion This prospective study of 489 consecutive outpatient PLBs, novel in the NHS setting, provides evidence for a paradigm shift in current UK lung biopsy practice: (i) early discharge PLB, facilitated by use of ambulatory HVCD, is safe and expeditious, thereby enabling more prompt lung cancer diagnosis; and (ii) use of outpatient HVCD is clinically and economically beneficial, saving precious hospital beds whilst also facilitating lung biopsy in severely emphysematous patients with negligible morbidity.