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Prediction of Postoperative Lung Function in Patients With Lung CancerPrediction of Lung Function Using CT Scan: The Role of Quantitative CT Imaging FREE TO VIEW

Chrysovalantis V. Papageorgiou, MD; Georgios Kaltsakas, MD; Nickolaos G. Koulouris, MD, PhD, FCCP
Author and Funding Information

From the Respiratory Function Laboratory, 1st Respiratory Medicine Department, “Sotiria” Hospital for Diseases of the Chest, University of Athens.

Correspondence to: Chrysovalantis V. Papageorgiou, MD, 1st Respiratory Medicine Department, “Sotiria” Hospital for Diseases of the Chest, University of Athens, 152 Mesogeion Ave, 11527 Athens, Greece; e-mail: valantispap@hotmail.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(4):927-928. doi:10.1378/chest.13-2971
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To the Editor:

We read with great interest the article by Brunelli et al1 in the third edition of the American College of Chest Physicians lung cancer guidelines published in CHEST (May 2013) regarding the physiologic evaluation of the patient being considered for resectional surgery. We certainly appreciate the clarity of the presented data and strongly believe that they provide an evidence-based approach to the preoperative evaluation of lung resection candidates.

Prediction of postoperative lung function has a key role in the proposed algorithm; however, we believe that the proposed method of performing this prediction, especially in case of lobectomy, is not optimal. The anatomic method based on the formula predicted postoperative FEV1 = preoperative FEV1 × (1 − y/z), where y is the functional or unobstructed lung segments to be removed, and z is the total functional segments, was proposed by Bolliger et al2 as a simpler alternative to the Nakahara formula (which took into account functional subsegments), since its predictive capability was equal to the latter. However, quantitative CT imaging has been tested in the prediction of postoperative lung function and has yielded more accurate predictions than the segment-counting method. Ueda et al3 demonstrated that volumetric analysis via quantitative CT imaging was better for estimating the functional contribution of a specific lung lobe, compared with segment counting, especially in cases where the functional contribution of every segment varies due to underlying diseases such as pulmonary emphysema or fibrosis, which may be heterogeneously distributed. Ohno et al4 demonstrated that the correlation coefficient was lower and the limits of agreement of the anatomic method were larger than those of quantitative CT imaging. Yoshimoto et al5 confirmed that the segment-counting method is inferior to quantitative CT imaging for predicting postoperative lung function after lobectomy.

Volumetric analysis via quantitative CT imaging is fast, accurate, and technically simple and is performed by analyzing the already existing data of the chest CT scan, which is available in any case, since it is routinely performed in all patients with lung cancer. The predictive capability of quantitative CT imaging has also been compared with perfusion scanning, and both methods yielded similar results, with small differences either in favor of perfusion scanning2 or in favor of quantitative CT imaging.4 We believe that quantitative CT imaging should be the method of choice in predicting postoperative lung function, not only after lobectomy but also after pneumonectomy, thus, obviating the need for perfusion scanning.

References

Brunelli A, Kim AW, Berger KI, Addrizzo-Harris DJ. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5_suppl):e166S-e190S. [CrossRef]
 
Bolliger CT, Gückel C, Engel H, et al. Prediction of functional reserves after lung resection: comparison between quantitative computed tomography, scintigraphy, and anatomy. Respiration. 2002;69(6):482-489. [CrossRef]
 
Ueda K, Tanaka T, Li TS, Tanaka N, Hamano K. Quantitative computed tomography for the prediction of pulmonary function after lung cancer surgery: a simple method using simulation software. Eur J Cardiothorac Surg. 2009;35(3):414-418. [CrossRef]
 
Ohno Y, Koyama H, Nogami M, et al. State-of-the-art radiological techniques improve the assessment of postoperative lung function in patients with non-small cell lung cancer. Eur J Radiol. 2011;77(1):97-104. [CrossRef]
 
Yoshimoto K, Nomori H, Mori T, et al. Prediction of pulmonary function after lung lobectomy by subsegments counting, computed tomography, single photon emission computed tomography and computed tomography: a comparative study. Eur J Cardiothorac Surg. 2009;35(3):408-413. [CrossRef]
 

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References

Brunelli A, Kim AW, Berger KI, Addrizzo-Harris DJ. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5_suppl):e166S-e190S. [CrossRef]
 
Bolliger CT, Gückel C, Engel H, et al. Prediction of functional reserves after lung resection: comparison between quantitative computed tomography, scintigraphy, and anatomy. Respiration. 2002;69(6):482-489. [CrossRef]
 
Ueda K, Tanaka T, Li TS, Tanaka N, Hamano K. Quantitative computed tomography for the prediction of pulmonary function after lung cancer surgery: a simple method using simulation software. Eur J Cardiothorac Surg. 2009;35(3):414-418. [CrossRef]
 
Ohno Y, Koyama H, Nogami M, et al. State-of-the-art radiological techniques improve the assessment of postoperative lung function in patients with non-small cell lung cancer. Eur J Radiol. 2011;77(1):97-104. [CrossRef]
 
Yoshimoto K, Nomori H, Mori T, et al. Prediction of pulmonary function after lung lobectomy by subsegments counting, computed tomography, single photon emission computed tomography and computed tomography: a comparative study. Eur J Cardiothorac Surg. 2009;35(3):408-413. [CrossRef]
 
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