Authors (including presenting author) :
Leung HS (1), Tsang PK (1), Law WC (1), Wong YS (1), Ngai CL (2), Wong KT (1)
Affiliation :
(1) Department of Imaging and Interventional Radiology, Prince of Wales Hospital (2) Department of Medicine and Therapeutics, Prince of Wales Hospital
Introduction :
Image-guided lung biopsy is a cornerstone for diagnosis and treatment planning for lung cancers, especially in the era of personalized sequences and genetic sequences. Traditionally, patient would require pre-procedural admission and post-procedural overnight observation for any complications. As majority of lung biopsy are safe and uncomplicated in carefully selected candidates, there is a potential to reduce bed-stay for these elective procedures with a well-structured protocol.
Objectives :
To explore the safety and feasibility of conducting image-guided lung biopsy as an ambulatory out-patient model.
Methodology :
Consecutive patients for image-guided lung biopsies were recruited from medical respiratory clinic of Prince of Wales Hospital. Patients were excluded if there were risk factors for increased complications of pneumothorax or pulmonary haemorrhage; or were assessed not fit for care at home immediately after biopsy. Eligible patients were seen by interventional radiologist and specialist nurse at interventional radiology ambulatory centre (IRAC) for pre-procedural assessment; followed by lung biopsy under same-day admission to IRAC. Patient were discharged from the IRAC directly if uneventful during and after procedure, including 4-hour post-procedural observation and two chest radiographs (CXR) showing absence of pneumothorax. These patients are subsequently followed up in the IRAC the next day with a third CXR to detect delayed pneumothorax. Patients were admitted directly to respiratory medical ward if there is suspicion of complications.
Result & Outcome :
A total of 59 patients were recruited between May and November 2024 under the ambulatory pathway. 68.7% of these patients (31/45) were able to achieve same day direct discharge from IRAC after lung biopsy. No unplanned readmission or emergency department attendance was observed after direct discharge from IRAC. Two patients were noticed to have delayed pneumothorax on the day after procedure and were managed conservatively. 31.1% (14/45) of patients were admitted after lung biopsy for complications including pneumothorax, or related to underlying comorbidities such as pre-existing pleural effusion or uncontrolled tumour pain. This ambulatory model has saved up 93 in-patient bed-days in total when compared with baseline, amounting to 1.8 bed days per patient within the cohort.
