Rationale and Objectives
Lung resection for primary bronchogenic carcinoma in the setting of chronic obstructive pulmonary disease often requires a detailed assessment of lung function to avoid perioperative complications and long-term disability. The aim of this study was to test the hypothesis that a novel technique of spiral computed tomographic (CT) subtraction imaging provides accuracy equal to the current standard of radioisotope perfusion scintigraphy in predicting postoperative lung function.
Methods and Materials
Preoperative lung function, radioisotope perfusion scintigraphy, spiral CT subtraction imaging, and assessment of postoperative lung function were performed in 25 patients with surgically resectable primary bronchogenic carcinoma. Comparisons of predicted postoperative lung function between the two modalities and to true postoperative lung function were performed using Pearson’s correlation and linear regression analysis.
Results
Among the 25 patients enrolled in the study, there was a high degree of agreement between the predicted value of postoperative forced expiratory lung volume in 1 second (FEV 1 ) generated on novel contrast CT subtraction imaging and that on radioisotope perfusion scintigraphy ( r = 0.96, P < .001). Furthermore, there was a strong correlation between the predicted and actual postoperative FEV 1 values for both imaging modalities ( r = 0.87, P < .001, and r = 0.88, P < .001, respectively), among the 14 patients completing the study protocol.
Conclusion
A novel technique of CT subtraction imaging is equally accurate at predicting postoperative lung function as radioisotope perfusion scintigraphy, which may obviate the need for additional nuclear imaging in the context of the preoperative assessment of resectable lung cancer in high-risk patients.
Primary bronchogenic carcinoma remains the leading cause of cancer death in both men and women worldwide . Despite advances in chemotherapy and radiation therapy, surgical resection continues to offer the best long-term survival for patients with localized non-small-cell lung cancer . Unfortunately, many of these patients also have chronic airflow limitations related to cigarette smoking, a factor that has been associated with an increased risk for perioperative complications and long-term disability following lung resection . As a result, a detailed physiologic assessment, including efforts to predict postoperative lung function, has become an integral component of the preoperative assessment for these patients.
Presently, the investigation most commonly used for the prediction of postoperative pulmonary function following lung resection surgery is quantitative radioisotope perfusion scintigraphy. Using perfusion as a surrogate for ventilation, this method enables the determination of relative contribution of the region of lung to be resected to the overall ventilatory function. Perfusion scintigraphy has been shown to be relatively accurate in predicting postoperatively the spirometric forced expiratory lung volume in 1 second (FEV 1 ) following resectional surgery, with correlation coefficients between predicted and true postoperative FEV 1 being variably reported from 0.81 to 0.92 . This demonstrated accuracy, combined with both the availability and noninvasive nature of this test, has led to its inclusion in the guidelines of the European Respiratory Society and the American College of Chest Physicians for patients with non-small-cell lung cancer and impaired lung function being evaluated for lung resection .
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Methods and materials
Patient Selection
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Study Design
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Spirometry
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Radioisotope Perfusion Scintigraphy
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Contrast CT Subtraction Imaging
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Surgical Procedures
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Statistical Analysis
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Results
Patients
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Table 1
Summary of Patient Demographics, Operations, and FEV 1 Data
PPO FEV 1 (L) Patient Age (y) Sex Preoperative FEV 1 (L) Surgical Procedure Radioisotope Perfusion Scintigraphy CT Imaging True Postoperative FEV 1 (L) 1 61 M 2.75 Lobectomy 2.20 2.05 2.05 2 56 F 0.68 Lobectomy 0.50 0.52 0.63 3 67 M 1.92 Bilobectomy 1.39 1.29 1.64 4 58 F 2.06 Pneumonectomy 1.15 1.05 1.23 5 73 M 2.00 Lobectomy 1.57 1.58 1.26 6 61 M 2.03 Lobectomy 1.77 1.87 Died 7 82 M 1.55 Lobectomy 1.49 1.36 Unresectable 8 52 M 1.96 Lobectomy 1.57 1.57 1.56 9 69 M 1.50 Pneumonectomy 1.02 0.95 Unresectable 10 75 F 1.48 Lobectomy 1.36 1.28 Died 11 66 M 0.98 Lobectomy 0.74 0.72 Unresectable 12 56 F 2.30 Lobectomy 2.16 1.68 1.75 13 51 F 2.95 Lobectomy 2.66 2.66 2.18 14 76 M 1.60 Pneumonectomy 0.88 0.72 1.35 15 55 F 2.10 Lobectomy 1.93 1.84 Died 16 71 M 1.86 Lobectomy 1.53 1.45 1.68 17 54 F 1.35 Lobectomy 1.21 1.31 Unresectable 18 73 F 0.92 Lobectomy 0.79 0.74 0.55 19 71 M 3.31 Pneumonectomy 3.01 1.92 2.62 20 75 M 1.98 Lobectomy 1.74 1.25 Unresectable 21 67 M 0.98 Lobectomy 0.92 0.84 Unresectable 22 52 F 2.21 Lobectomy 1.64 1.68 2.02 23 76 M 2.23 Lobectomy 2.03 1.81 1.91 24 54 M 2.71 Pneumonectomy 1.81 1.70 Unresectable 25 78 F 0.99 Lobectomy 0.84 0.79 Unresectable
CT, computed tomographic; FEV1, forced expiratory volume in 1 second.
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Surgical Procedures and Outcomes
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Agreement Between Imaging Modalities
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Accuracy of Predicting Postoperative Lung Function
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Discussion
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