Prediction of the postoperative pulmonary function in lung cancer patients with borderline function using ventilation-perfusion scintigraphy

Objectives To predict the postoperative pulmonary function and evaluate the feasibility of surgery in the lung cancer patients with borderline pulmonary functions (forced expiratory volume in 1 second [FEV1] < 2.0L for pneumonectomy or <1.5L for lobectomy) using ventilation-perfusion scintigraphy.

Methods Twenty lung cancer patients (52-86 yrs, 4F,16M) with borderline pulmonary functions were included in the study. Planar ventilation scans with 99mTc-diethylenetriamine pentaacetic acid (DTPA) aerosol and perfusion scans with 99mTc-macroaggregated albumin (MAA) were performed pre-surgery. Pulmonary function test was performed in 1 week pre-surgery for all patients and at 2 months post-surgery for twelve patients. The predicted postoperative FEV1 (ppoFEV1) values were calculated according to Neuhaus’ equations, and compared with the measured FEV1 values post-surgery.

Results There was no statistic significant difference between the ventilation ppoFEV1 values and the perfusion ppoFEV1values: (1.153±0.227) L vs (1.204±0.210) L (n=20, t=0.045, P>0.05). Neither statistic significant difference between the ventilation ppoFEV1 values and the postoperative measured FEV1 values: (1.238±0.200) L vs (1.28±0.146) L (n=12, t=0.557, P>0.05), nor between the perfusion ppoFEV1 values and the postoperative measured FEV1 values: (1.302±0.161) L vs (1.28±0.146) L (n=12, t=0.288, P>0.05) was observered. The ventilation ppoFEV1 values and the perfusion ppoFEV1 values fairly correlated with the postoperative measured FEV1 values respectively (r=0.765, 0.674, P<0.01).

Conclusions Ventilation-perfusion scan can help in decision-making of surgery and accurately predict the postoperative pulmonary function in the lung cancer patients with borderline pulmonary functions