PDX Biopsy

(Those who faint when reading about blood may want to skip this one.)

On Tuesday, I went down to London to have the biopsy for the PDX trial in which I’m taking part. The biopsy happened at the Royal Marsden hospital in Chelsea on Wednesday morning. It was a CT-guided needle biopsy, which means that they use a CT scanner in near-real-time to guide a hollow needle towards the lump to be sampled, and the sample extraction needle is then passed down that needle to take multiple samples.

At least, that’s what happens when it all goes well. :-)

The target, I found out on the day, was an isolated tumour in the top corner of my left lung. As they were biopsying my lungs, which are not a stable target, I had to both stay very still, and achieve a consistent size of “held breath”, so that when they moved the needle or did a scan, everything was in pretty much the same place. I was placed on the CT scanner table, and they used a lead-or-similar grid placed on my chest to find the optimum point of entry. They then injected generous quantities of local anaesthetic (a process which itself stings) and started inserting the needle. After each movement, they stopped, slid me into the scanner, told me to take a standard breath, and used the scan to see where the needle was and whether the track needed correction.

All went fairly smoothly until the needle passed through the outer wall of the lung itself. At this point, I started bleeding into my lung, which (although I tried to suppress it) led to significant amounts of convulsive coughing. They had to use suction to remove the liquid from my mouth. One nurse said afterwards that she thought they might well have abandoned the procedure at this point. In someone as young as me, this complication at this point is fairly rare. Of course, coughing so much, I was not able to hold still or take the standard breath, and it was dangerous to move the needle any further.

After a couple of minutes, I managed to get the coughing under control, although later I opened my eyes for a short time and saw blood spatters all over the inside of the CT machine! Once I was stable again, they were able to continue inserting the needle and were able to get 8 good “cores” of sample for use in the PDX trial.

However, a final whole-chest scan revealed that all that jerking about had given me a small pneumothorax, which is where air gets into the pleural space, between the lung and the chest wall. So I had to stay there for longer while they inserted a second needle into a different part of me and attempted to suck out the introduced air. This took less long, and was mostly successful. Any remaining air should, God willing, be reabsorbed in the next week or so.

Towards the end, I asked what my heart rate was; they said “66”. That’s the peace of God in action, I thought. The nurses joked that we should measure the heart rate of the surgeon! :-)

I was sent to the recovery room and then to the Clinical Assessment Unit. After 3 hours, they did a chest X-ray, then after another 2 hours another one, to check that I was stable and the remaining tiny pneumothorax was not growing. It wasn’t, so they let me go home. But I have another X-ray in a week, here in Sheffield, to make sure everything is OK and I’m fine to fly to the USA the following Monday :-)

3 thoughts on “PDX Biopsy

  1. Sounds harrowing!!! Hope you are all otherwise well ;-)

    Give me a yell when you’re in London some time and we can grab a coffee.