title: Lung cancer tissue diagnosis in poor lung function: addressing the ongoing percutaneous lung biopsy FEV1 paradox using Heimlich valve.
abstract: Many centres continue to decline percutaneous lung biopsy (PLB) in patients with poor lung function (particularly FEV1 <1 L) due to the theoretically increased risk of pneumothorax. This practice limits access to novel lung cancer therapies and minimally invasive surgical techniques. Our retrospective single-centre analysis of 212 patients undergoing PLB, all performed prospectively and blinded to lung function, demonstrates that using ambulatory Heimlich valve chest drain (HVCD) to treat significant postbiopsy pneumothorax facilitates safe, diagnostic, early discharge lung biopsy irrespective of lung function with neither FEV1 <1 L nor transfer coefficient for carbon monoxide (TLCO) <40% predicted shown to be independent predictors of HVCD insertion or pneumothorax outcomes. Incorporating ambulatory HVCD into standard PLB practice thereby elegantly bridges the gap that currently exists between tissue diagnosis in patients with poor lung function and the advanced therapeutic options available for this cohort.
authors.affiliation: Department of Respiratory Medicine, Barnet General Hospital, Royal Free London NHS Foundation Trust, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Abdullah
authors.affiliation: Department of Radiology, Barnet General Hospital, Royal Free London NHS Foundation Trust, London, UK.
authors.forename: A N
authors.initials: AN
authors.lastname: Tavare
authors.affiliation: Department of Respiratory Medicine, Barnet General Hospital, Royal Free London NHS Foundation Trust, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Creamer
authors.affiliation: Department of Respiratory Medicine, Barnet General Hospital, Royal Free London NHS Foundation Trust, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Creer
authors.affiliation: Department of Respiratory Medicine, Barnet General Hospital, Royal Free London NHS Foundation Trust, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Vancheeswaran
authors.affiliation: Department of Radiology, Barnet General Hospital, Royal Free London NHS Foundation Trust, London, UK.
authors.forename: S S
authors.initials: SS
authors.lastname: Hare
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001706:Biopsy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000628:therapy*; D008297:Male; D010045:Outpatients; D011013:Pneumonectomy / Q000379:methods; D011446:Prospective Studies; D016634:Radiosurgery / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: Lung Cancer