Invasive diagnostic investigation-related complications and its impact on treatment initiation in lung cancer patients in a rapid access lung lesion clinic in regional Australia.

Abstract

Background: Rapid Access Lung Lesions Clinic (RALLC) is designed to expedite the diagnostic pathway of suspected lung cancer, to allow treatment in a timely fashion. Invasive investigations (i.e. bronchoscopy, EBUS biopsy, CT-guided biopsy) are the usual tools to obtain tissue for histological diagnosis and each carries a small procedure-related complications risk, which could potentially delay definitive treatment initiation until the complication resolves. Methods: Data was prospectively collected of all patients referred to a RALLC clinic in a tertiary cancer centre in regional Australia between July 2017 and December 2018. The need and choice of invasive investigation was determined based on tumour location, clinical suspicion of malignancy and multidisciplinary recommendation. Time to treatment was calculated from the date of diagnostic investigation to the first date of treatment (i.e. chemo/radio/immunotherapy, surgery). All data were analysed using descriptive statistics. Results: Over 18-months 202 patients were referred to the RALLC clinic for evaluation. 105 patients underwent invasive investigation [CT-guided lung biopsy 46 (44%), Bronchoscopy 32 (30%), EBUS biopsy 22 (21%) & Surgical biopsy 5 (5%)]. Malignancy was confirmed in 89 patients (85% diagnostic yield), 80 being lung cancer. The only investigation-related complication was pneumothorax, which occurred in 15 of the CT-guided lung biopsy (33%) with 11 patients needing hospital admission. The median time to first treatment for the overall cohort of lung biopsy patients was 28 days (mean 28.3, range 0-72). In the non-pneumothorax group, the median was 27 days (mean 27.7, range 0-65) while the pneumothorax group was 29 days (mean 29.8, range 5-72). Conclusions: Although CT-guided lung lesion biopsy resulted in a significant number of pneumothorces in our cohort of patients, ultimately this did not significantly delay definitive treatment compared to the overall cohort. However, the high pneumothorax rate increases health care burden and additional invasive management procedures for the patient. Further investigation is warranted to explore factors associated with this.