Establishing Your Diagnosis Lung Investigations Explained

Patient Information

Introduction This leaflet tells you about tests that may be performed to investigate the cause of your chest symptoms or the abnormal findings on your X-ray. This leaflet is not meant to replace the discussion between you and your consultant but helps you to understand more about what is discussed. During your first hospital visit you will see one of the doctors of the respiratory team who will take a medical history and do a physical examination. You may require one or more of the investigations below which are used to diagnose infection, pneumonia, scar tissue or more serious conditions such as tuberculosis or cancer of the lung. You will receive detailed information about the tests and investigations you need, with your appointment letter. These will outline the benefits, risks and any alternatives of the procedure(s) that have been recommended for you. If you do not receive this information, please ask a member of the medical team looking after you. Sometimes tests need to be repeated to ensure the correct diagnosis. If you need any more information then your consultant or clinical nurse specialist will be happy to explain more about the tests you are having. Blood tests These can help find out about your general health and how well your kidneys and liver are working. Flexible bronchoscopy A bronchoscopy is a common test performed to examine the lungs and airways and is carried out under local anaesthetic. A doctor passes a thin flexible tube called a bronchoscope through the nose or mouth, through the air passages and into the lungs. Photographs and samples or biopsies will be taken. These are then examined under the microscope and the results discussed at your next clinic visit. Additional, detailed information will be given to you if you require this test (see patient information leaflet Flexible Bronchoscopy Explained). Endobronchial ultrasound An endobronchial ultrasound (EBUS) is a similar test to a bronchoscopy and performed under local anaesthetic and sedation. A doctor passes a thin flexible tube called a bronchoscope through the mouth and air passages into the lung. The bronchoscope has an ultrasound probe attached which allows the doctor to see any enlarged lymph nodes through the wall of the wind pipe and take a
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biopsy via a needle passed through the bronchoscope. These samples are then examined under a microscope and results discussed with you at the next clinic visit. CT (Computerised Tomography) scan CT scan uses special X-ray equipment to obtain many images from different angles. A specially designed computer programme joins the images together to show detailed pictures of the inside of the body. A CT scan can help to give more information regarding the abnormality seen on your X-ray. The scan is painless and takes around 10 minutes. CT scans give a small amount of radiation, which is very unlikely to harm you. You can usually go home as soon as the scan is over. CT (Computerised Tomography) guided biopsy A biopsy is a procedure in which a small piece of tissue is removed and examined under a microscope. Sometimes the CT scan shows an abnormal area or shadow that is close to the outside of the lungs or in a position that is easy to access by using a biopsy needle. A radiology doctor will usually take the biopsy and decide the best place to take it from using the CT scanner. The biopsy usually takes about 15 minutes and some discomfort is possible. A local anaesthetic is injected into the area before the biopsy is taken to reduce any discomfort. Additional information is available on the patient information leaflet given to you by the imaging department or your clinical specialist nurse (see patient information leaflet CT Guided Lung Biopsy Explained). Echocardiogram test (also known as echo test) This is a similar test to an ultrasound scan (see below) but is done to examine your heart function. It is usually suggested if you have some history of heart problems and can be recommended prior to surgery. Ultrasound scan Ultrasound uses high frequency sound waves which are transmitted through the skin to build up a picture of the inside of your body. This is the same sort of test used on pregnant women. Ultrasound imaging is painless, usually fast and easy. You will be asked to lie on your back on an examining table. Gel is put onto the skin in the area to be scanned and a small, hand-held scanner is passed over that area. A computer converts the reflected sound waves into a picture on a television screen.

The procedure is not painful, but there may be varying degrees of discomfort from pressure as the probe moves over your skin. The process takes around 10 to 15 minutes. Lung function tests These are tests to establish how well your lungs are working (air / oxygen capacity). These may help decide on appropriate treatment for you if have other lung conditions, such as emphysema or Chronic Obstructive Pulmonary Disease (COPD). These simple tests usually involve blowing into machines via a mouthpiece. Quantitative perfusion scan This is a simple test sometimes suggested to assess how well supplied your lungs are with blood. This is known as perfusion. It may be recommended if your doctors think you may be suitable for an operation. It takes about 20 minutes and involves having an injection of a harmless radioactive substance which develops a picture on a computer screen. The test is not harmful and has no lasting effects. PET (Positron Emission Tomography) scan A PET scan is an imaging technique that uses small amounts of a radioactive tracer (similar to sugar). This injection is harmless and leaves the body with no ill effects. It produces images on a television screen, highlighting possible abnormalities. CT uses X-rays to produce pictures showing the different organs in the body. By combining these two techniques important information can be provided to your doctors to help plan appropriate treatment. This test lasts two to three hours and is usually performed at the Queen Elizabeth Hospital in Birmingham. Pleural aspiration and biopsy These tests are carried out when you have a collection of fluid in your lung. The easiest way to find out what is causing this collection is to take samples of the fluid (this is called an aspiration) and to take a small biopsy of the pleura (the membrane that covers the lungs). These samples are examined under a microscope. Some discomfort is possible but you will be given a local anaesthetic before the biopsy needle is used. The procedure usually takes about 30 minutes or possibly longer if the collection of fluid is being drained. Additional information will be given to you if you require this test, see patient information leaflet Pleural

Aspiration, Pleural Biopsy with Insertion of Inter-costal Tube and Pleurodesis Explained. Sputum test Examining a sample of your spit (sputum) may assist in establishing if you have any infection or abnormal cells present. Bone scan Sometimes patients with chest symptoms experience pain in their bones. This could be anywhere in the body, although it is often in the larger bones. If you are experiencing pain in your bones it could be related to your chest symptoms or it could be something completely different. A bone scan will only be done after you have discussed your symptoms with a doctor in the clinic and is one way to find out the cause of any bone pain you are experiencing. A small amount of a mildly radioactive substance is injected into a vein, usually in your arm. The radioactivity used in these scans is very low and not harmful. It disappears from the body within a few hours. A bone scan shows up abnormal areas of bone more clearly because abnormal bone absorbs more radioactivity than normal bone. There is generally a wait of approximately two to three hours between receiving the injection and the scan taking place. Your doctor will look at the images created by the scanner and use them to find out more about your condition. You will then be able to meet and discuss the results further. A second appointment will be made with you for this meeting. Rigid bronchoscopy Similar to flexible bronchoscopy, this is a minor operation carried out by a thoracic (chest) surgeon. You will need to have a general anaesthetic and a short stay in hospital which could be overnight. Other surgical tests may be carried out at the same time. Additional information will be given to you about any tests that you require. Mediastinoscopy This is minor operation carried out by a thoracic surgeon. This test looks at the lymph nodes, which are glands at the centre of your chest. You will need to have a general anaesthetic and a short stay in hospital which could be overnight. A small cut is made at the base of the neck so that a small camera can be passed into the chest to look at the lymph nodes. The surgeon can then take samples, which will
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be studied under a microscope. Additional information will be given to you if you require this test. Video Assisted Thoracoscopy (VATS) biopsy A VATS Biopsy is similar to a mediastinoscopy (described above). It is an operation carried out by a thoracic surgeon. This test looks at your lungs and you will need to have a general anaesthetic and will usually stay in hospital for several nights. Small cuts will be made on the side of the chest so that a small camera can be passed into the chest to examine the lungs. The surgeon can then take samples, which will be studied under a microscope. Additional information will be given to you if you require this test. Open lung biopsy If a biopsy is not possible using one of the above procedures it may be necessary for the surgeon to make an opening in the side of the chest to take the biopsy. You will need to have a general anaesthetic and will usually stay in hospital for several nights. Additional information will be given to you if you require this test. Thoracoscopy, frozen section and proceed This is an operation carried out by a thoracic surgeon. You will need to have a general anaesthetic and will usually stay in hospital for several nights. The thoracosopy is carried out to take biopsies that are immediately studied under a microscope. While the biopsies are being studied you are still under the anaesthetic, the surgeon is given the results. Depending on the results from the biopsies the surgeon may then to carry out further surgery. If you are having this procedure you will be given additional information about this possible surgery. Some of these test results will be available immediately but most tests will take several days for the results to be ready. If you have any tests carried out you should have a follow up appointment made before you go home. If for some reason this has not happened or if you have additional questions please contact your clinical nurse specialist. Name_____________________________________________________ Phone number_____________________________________________ It is important that you make a list of all medicines you are taking and bring it with you to all your follow-up clinic appointments. If you have any questions at all, please ask your doctor or nurse specialist. It may help to write down questions as you think of
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them so that you have them ready. It may also help to bring someone with you when you attend your outpatient appointments. Local support groups Please visit on our website for details of local support groups: www.birminghamcancer.nhs.uk Local sources of further information You can visit any of the health/cancer information centres listed below: Heart of England NHS Foundation Trust Health Information Centre Birmingham Heartlands Hospital Bordesley Green Birmingham B9 5SS Telephone: 0121 424 2280 Cancer Information and Support Centre Good Hope Hospital Rectory Road Sutton Coldfield B75 7RR Telephone: 0121 424 9486 Sandwell and West Birmingham Hospitals NHS Trust The Courtyard Centre Sandwell General Hospital (Main Reception) Lyndon West Bromwich B71 4HJ Telephone: 0121 507 3792 Fax: 0121 507 3816 University Hospitals Birmingham NHS Foundation Trust The Patrick Room Cancer Centre Queen Elizabeth Hospital Edgbaston Birmingham B15 2TH Telephone: 0121 371 3537/39 Walsall Healthcare NHS Trust Information and Support Services Walsall Palliative Care Centre Goscote Lane

Walsall WS3 1SJ Telephone: 0800 783 9050 About this information This guide is provided for general information only and is not a substitute for professional medical advice. Every effort is taken to ensure that this information is accurate and consistent with current knowledge and practice at the time of publication. We are constantly striving to improve the quality of our information. If you have a suggestion about how this information can be improved, please contact us via our website: www.birminghamcancer.nhs.uk This information was produced by Pan Birmingham Cancer Network and was written by Consultant Surgeons, Clinical Nurse Specialists, Allied Health Professionals, Patients and Carers from the following Trusts: Heart of England NHS Foundation Trust Sandwell and West Birmingham NHS Trust University Hospitals Birmingham Foundation Trust Walsall Healthcare NHS Trust We acknowledge the support of Macmillan in producing this information. Pan Birmingham Cancer Network 2011 Publication Date: Feb 2011 Review Date: Feb 2014