Elsevier

The Annals of Thoracic Surgery

Volume 82, Issue 5, November 2006, Pages 1828-1834
The Annals of Thoracic Surgery

Original article
General thoracic
Usefulness of Lung Perfusion Scintigraphy Before Lung Cancer Resection in Patients with Ventilatory Obstruction

Presented at the Poster Session of the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006.
https://doi.org/10.1016/j.athoracsur.2006.05.041Get rights and content

Background

The study was conducted to evaluate the efficacy of preoperative lung perfusion scintigraphy performed by planar acquisition and single-photon emission computed tomography (SPECT) in predicting postoperative pulmonary function of patients with resectable lung cancer and obstructive ventilatory defect.

Methods

The study enrolled 39 patients (mean age, 67 ± 2.1 years). All patients underwent preoperative and postoperative pulmonary function tests. Cut-off values for postoperative forced expiratory volume in 1 second (FEV1) were 65% of the predicted value for pneumonectomy and 45% for lobectomy. A semiquantitative analysis of planar and SPECT lung perfusion scintigraphy images was performed preoperatively to estimate postoperative predicted FEV1 (FEV1ppo). Relationships between FEV1ppo and measured postoperative FEV1 were tested by the Pearson correlation and Bland Altman agreement tests.

Results

Twenty-eight lobectomies and 11 pneumonectomies were performed. The FEV1ppo estimated by mean planar lung scintigraphy was 1.85 ± 0.38 L, with a Pearson correlation coefficient to the measured FEV1 of 0.8632 (p < 0.001). The mean FEV1ppo estimated by SPECT was 1.78 ± 0.31 L, with a Pearson coefficient to the measured FEV1 of 0.8527 (p < 0.001). Both values showed a more significant correlation with postoperative measured FEV1 after lobectomy (p < 0.001) than after pneumonectomy (p = 0.045). The Bland Altman test confirmed satisfactory agreement of FEV1ppo estimated by both planar lung scintigraphy and SPECT with FEV1 measured by spirometry.

Conclusions

Both planar lung scintigraphy and SPECT can accurately predict postoperative FEV1 and can therefore be considered reliable tools in establishing operability of patients with lung cancer and ventilatory obstruction.

Section snippets

Patients and Methods

A prospective study was conducted on 39 patients (31 men, 8 women) with a mean age of 67 ± 2.1 who had anatomic resection for lung cancer between January 2004 and January 2005. The ethics committee of the Tor Vergata University approved the study, and written informed consent was obtained from all recruited patients.

Preoperative and postoperative (60 ± 22 days) pulmonary function tests were performed according to the American Thoracic Society guidelines [4]. The preoperative evaluation included

Results

Of 39 operated patients, 28 subjects underwent lobectomy and 11 had pneumonectomy. Histologic diagnosis was squamous cell carcinoma in 22 patients, adenocarcinoma in 11, and large cell carcinoma in 6. Preoperative and postoperative data of each patient are summarized in Table 1. The overall mean preoperative FEV1% was 59.41% ± 5.44%, with a mean of 61.54% ± 3.2% in patients undergoing a pneumonectomy and 58.57% ± 6.6% in those undergoing a lobectomy. Correlations are listed in Table 2.

The mean

Comment

Prediction of postsurgical pulmonary function is crucial in limiting morbidity and mortality after lung resection in patients with ventilatory obstruction, making accurate preoperative evaluation the key to successful outcome [2, 3, 4, 6, 7, 10, 11]. Measurement of ventilatory indexes, including FEV1, diffusing capacity of the lungs for carbon monoxide, and maximal oxygen uptake, usually represents the first step of this evaluation process, although the usefulness of each of these indexes

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