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Buttery SC, Lewis A, Alzetani A, Bolton CE, Curtis KJ, Dodd JW, Habib AM, Hussain A, Havelock T, Jordan S, Kallis C, Kemp SV, Kirk A, Lawson RA, Mahadeva R, Munavvar M, Naidu B, Rathinam S, Shackcloth M, Shah PL, Tenconi S, Hopkinson NS. Survival following lung volume reduction procedures: results from the UK Lung Volume Reduction (UKLVR) registry. BMJ Open Respir Res 2024; 11:e002092. [PMID: 38423954 PMCID: PMC10910650 DOI: 10.1136/bmjresp-2023-002092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/26/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Lung volume reduction surgery (LVRS) and endobronchial valve (EBV) placement can produce substantial benefits in appropriately selected people with emphysema. The UK Lung Volume Reduction (UKLVR) registry is a national multicentre observational study set up to support quality standards and assess outcomes from LVR procedures at specialist centres across the UK. METHODS Data were analysed for all patients undergoing an LVR procedure (LVRS/EBV) who were recruited into the study at participating centres between January 2017 and June 2022, including; disease severity and risk assessment, compliance with guidelines for selection, procedural complications and survival to February 2023. RESULTS Data on 541 patients from 14 participating centres were analysed. Baseline disease severity was similar in patients who had surgery n=244 (44.9%), or EBV placement n=219 (40.9%), for example, forced expiratory volume in 1 s (FEV1) 32.1 (12.1)% vs 31.2 (11.6)%. 89% of cases had discussion at a multidisciplinary meeting recorded. Median (IQR) length of stay postprocedure for LVRS and EBVs was 12 (13) vs 4 (4) days(p=0.01). Increasing age, male gender and lower FEV1%predicted were associated with mortality risk, but survival did not differ between the two procedures, with 50 (10.8%) deaths during follow-up in the LVRS group vs 45 (9.7%) following EBVs (adjusted HR 1.10 (95% CI 0.72 to 1.67) p=0.661) CONCLUSION: Based on data entered in the UKLVR registry, LVRS and EBV procedures for emphysema are being performed in people with similar disease severity and long-term survival is similar in both groups.
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Affiliation(s)
- S C Buttery
- National Heart and Lung Institute, Imperial College, London, UK
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Lewis
- Department of Health Sciences, Brunel University London, Uxbridge, UK
| | - A Alzetani
- University Hospital Southampton, Southampton, UK
| | - C E Bolton
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
- Nottingham University Hospitals Trust, City Hospital Campus, Nottingham, UK
| | - K J Curtis
- University Hospitals Bristol and Weston, Bristol, UK
| | - J W Dodd
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- North Bristol Lung Centre, North Bristol NHS Trust, Bristol, UK
| | - A M Habib
- New Cross Hospital, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - A Hussain
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - T Havelock
- University Hospital Southampton, Southampton, UK
| | - S Jordan
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - C Kallis
- National Heart and Lung Institute, Imperial College, London, UK
| | - S V Kemp
- National Heart and Lung Institute, Imperial College, London, UK
- Nottingham University Hospitals Trust, City Hospital Campus, Nottingham, UK
| | - A Kirk
- Department of Thoracic Surgery, West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital, West Dunbartonshire, Scotland, UK
| | - R A Lawson
- Northern General Hospital, Sheffield, UK
| | | | - M Munavvar
- Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | - B Naidu
- Heartlands Hospital, Birmingham Teaching Hospitals, Birmingham, UK
| | - S Rathinam
- Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - M Shackcloth
- Liverpool Heart and Chest Hospital, Liverpool, UK
| | - P L Shah
- National Heart and Lung Institute, Imperial College, London, UK
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S Tenconi
- Northern General Hospital, Sheffield, UK
| | - N S Hopkinson
- National Heart and Lung Institute, Imperial College, London, UK
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Barnett J, Pulzato I, Javed M, Lee YJ, Choraria A, Kemp SV, Rice A, Jordan S, Shah PL, Nicholson AG, Padley S, Devaraj A. Radiological-pathological correlation of negative CT biopsy results enables high negative predictive value for thoracic malignancy. Clin Radiol 2020; 76:77.e9-77.e15. [PMID: 33059852 DOI: 10.1016/j.crad.2020.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022]
Abstract
AIM To evaluate multidisciplinary team (MDT) practice of radiological-pathological correlation of non-malignant biopsy results to examine the additive effect on the predictive values of computed tomography (CT) biopsy for malignancy and their subsequent management and outcomes. MATERIALS AND METHODS A service evaluation of the MDT management of non-malignant lung biopsy results (May 2014- May 2017) was undertaken. RESULTS Sixty patients had a non-malignant diagnosis on initial CT biopsy. Five patients were lost to follow-up leaving 55 in the final cohort. Forty-eight of the 55 patients had biopsy results classified as potentially non-specific, of which 26 were classified as concordant with radiology (e.g., organising pneumonia with compatible CT features), and 22 were classified as discordant (e.g., non-specific inflammation and yet sufficiently suspicious CT features). Patients with concordant negative pathology showed resolution (n=19) or stability (n=6) on imaging follow-up. One lesion demonstrated growth and was proven malignant on surgical resection. Discordant lesions were managed with repeat biopsy (n=8) or surgical resection (n=13), with 12 final benign diagnoses and nine malignancies. The negative predictive value of CT biopsy alone was 44/55 (80%), following repeat biopsy was 44/50 (88%), and following radiological-pathological assessment was 32/33 (97%). No patients underwent a shift in stage from time of biopsy to resection. CONCLUSION Combining radiological-pathological interpretation of negative biopsy results offers superior negative predictive value for lung malignancy without delayed diagnosis of lung cancer.
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Affiliation(s)
- J Barnett
- Department of Radiology, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK.
| | - I Pulzato
- Department of Radiology, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK
| | - M Javed
- Department of Radiology, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK
| | - Y J Lee
- Department of Radiology, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK
| | - A Choraria
- Department of Radiology, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK
| | - S V Kemp
- Department of Respiratory Medicine, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK
| | - A Rice
- Department of Pathology, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK
| | - S Jordan
- Department of Thoracic Surgery, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK
| | - P L Shah
- Department of Respiratory Medicine, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK; National Heart & Lung Institute, Imperial College London, Cale Street, London, SW3 6LY, UK
| | - A G Nicholson
- Department of Pathology, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK; National Heart & Lung Institute, Imperial College London, Cale Street, London, SW3 6LY, UK
| | - S Padley
- Department of Radiology, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK; National Heart & Lung Institute, Imperial College London, Cale Street, London, SW3 6LY, UK
| | - A Devaraj
- Department of Radiology, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK; National Heart & Lung Institute, Imperial College London, Cale Street, London, SW3 6LY, UK
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Hopkinson NS, Kemp SV, Toma TP, Hansell DM, Geddes DM, Shah PL, Polkey MI. Atelectasis and survival after bronchoscopic lung volume reduction for COPD. Eur Respir J 2010; 37:1346-51. [PMID: 20947683 DOI: 10.1183/09031936.00100110] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Bronchoscopic therapies to reduce lung volumes in chronic obstructive pulmonary disease are intended to avoid the risks associated with lung volume reduction surgery (LVRS) or to be used in patient groups in whom LVRS is not appropriate. Bronchoscopic lung volume reduction (BLVR) using endobronchial valves to target unilateral lobar occlusion can improve lung function and exercise capacity in patients with emphysema. The benefit is most pronounced in, though not confined to, patients where lobar atelectasis has occurred. Few data exist on their long-term outcome. 19 patients (16 males; mean±sd forced expiratory volume in 1 s 28.4±11.9% predicted) underwent BLVR between July 2002 and February 2004. Radiological atelectasis was observed in five patients. Survival data was available for all patients up to February 2010. None of the patients in whom atelectasis occurred died during follow-up, whereas eight out of 14 in the nonatelectasis group died (Chi-squared p=0.026). There was no significant difference between the groups at baseline in lung function, quality of life, exacerbation rate, exercise capacity (shuttle walk test or cycle ergometry) or computed tomography appearances, although body mass index was significantly higher in the atelectasis group (21.6±2.9 versus 28.4±2.9 kg·m(-2); p<0.001). The data in the present study suggest that atelectasis following BLVR is associated with a survival benefit that is not explained by baseline differences.
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Affiliation(s)
- N S Hopkinson
- NIHR Respiratory Disease Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital Campus, London, SW3 6NP, UK.
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