P254 Physician-led ultrasound-guided transthoracic biopsy outcomes within an interventional pulmonology service

Abstract

Introduction With the introduction of the National Optimal Lung Cancer Pathway, rapid access to image-guided biopsies has become essential. In many centres, this service is provided through interventional radiology and can introduce delays. In response to this need, our interventional pulmonology service commenced targeted biopsies of peripheral lung masses and pleural-based lesions that were visible on thoracic ultrasound (TUS). Methods Suitable patients were identified by the interventional pulmonology team after review of CT imaging and TUS. All biopsies were performed under direct TUS guidance with an 18G core cutting needle (Argon super-core), by a respiratory consultant and/or training registrar, with a minimum of level 1 TUS Royal College of Radiologists competence. Post-procedure, TUS was recorded, followed by interval chest X-ray(s) at 1 (all procedures) and 4 hours (lung biopsies). Results Between September 2017 and July 2018, 40 patients with a median age of 75 years [IQR 70–79] were biopsied. The median time from referral to intervention was 2 days [1–6]. 31/40 (77%) procedures were performed as a day-case. A median number of 6 [5–8] biopsies were taken during each procedure. All biopsies were histologically representative and were sufficient for molecular testing. A true diagnosis was made in 37/40 (93%) patients. Of the 3 non-diagnostic cases, one lung biopsy was necrotic and a diagnosis of malignancy was made on bronchoscopy; whilst two pleural biopsies had a diagnosis of malignancy made on pleural fluid cytology and EBUS respectively. Complications occurred in 1/40 (2%) patients; a pneumothorax post-pleural biopsy, recognised on post-procedural TUS, and managed with a chest drain. Conclusion Physician-led TUS-guided transthoracic biopsy in patients undergoing investigation for suspected thoracic malignancy is associated with a high diagnostic yield and low complication rate. This service can streamline diagnostic pathways, whilst reducing dependence on and waiting times for radiology.