Evaluating The Outcomes Of Patients With Haemoptysis Referred To Two Rapid-Access Lung Cancer Clinics In The Uk

Background: Lung cancer is the leading cause of cancer death in the UK. There is pressure to expedite the diagnostic pathway. This study aimed to evaluate patients with haemoptysis to determine whether investigations could be rationalised. Methods: Patients referred to two UK rapid-access lung cancer clinics between 01/01/2017 & 31/12/2017 were included. Electronic case records & imaging were reviewed for patient characteristics, investigations & final diagnoses. Results: 835 patients were identified. 216/835 presented with haemoptysis (Table 1). 41/216 patients with haemoptysis were diagnosed with cancer; all had abnormal CT, although 3 had a normal CXR. 84/216 patients with haemoptysis had normal CTs. 41 of these had a bronchoscopy. No patient with a normal CT was diagnosed with cancer. Haemoptysis alone had a positive predictive value (PPV) for a non-cancer diagnosis of 81.0%, with a specificity of 83.2%. Haemoptysis & normal CXR had a 97.4% PPV for non-cancer, with a specificity of 98.8%. Haemoptysis & normal CT was 100% specific for a non-cancer diagnosis. Conclusion: British Thoracic Society Guidelines recommend bronchoscopy in patients with haemoptysis and a normal CT if there is a high suspicion of lung cancer. These data, from a large, representative patient population, suggest that CT imaging can reliably exclude cancer in patients with haemoptysis, and therefore bronchoscopy may not be indicated.