More Americans die of lung cancer than of any other malignancy. In 2004, there will be 173,770 cases and 160,440 deaths due to the disease.1 The majority of these cases will be locally advanced or metastatic when they are diagnosed, precluding any surgical resection. When technically feasible, surgery offers the only possibility for cure.
Because of the presence of a common risk factor (ie, smoking), lung cancer tends to develop in patients with concomitant cardiopulmonary limitations. Lung resection poses a significant stress to the cardiopulmonary system, so the importance of identifying patients who will tolerate surgery from among those who are anatomically resectable becomes evident. The search for the ideal preoperative test that would identify these patients with certainty has been ongoing for decades. Routine pulmonary function tests including spirometry and measurement of the diffusion capacity of the lung as well as quantitative radionuclide perfusion lung scanning have all been utilized, with variable degrees of accuracy.