TY - JOUR
T1 - Patient selection for lung volume reduction surgery
T2 - An objective model based on prior clinical decisions and quantitative CT analysis
AU - Gierada, David S.
AU - Yusen, Roger D.
AU - Villanueva, Ian A.
AU - Pilgram, Thomas K.
AU - Slone, Richard M.
AU - Lefrak, Stephen S.
AU - Cooper, Joel D.
N1 - Funding Information:
Supported in part by the American Lung Association of Eastern Missouri.
PY - 2000
Y1 - 2000
N2 - Objectives: We used whole-lung quantitative CT analysis (QCT) - an objective method of evaluating emphysema severity and distribution based on measurement of lung density - to determine whether subjective selection criteria for lung volume reduction surgery are applied consistently and to model the patient selection process, and assessed the relationship of the model to postoperative outcome. Design: Logistic regression analysis using QCT indexes of emphysema and preoperative physiologic test results as the independent variables, and the decision to operate as the dependent variable. Setting: University hospital. Patients: Seventy patients selected for bilateral lung volume reduction surgery and 32 otherwise operable patients excluded from surgery based on subjective assessment of emphysema morphology on chest radiography, CT, and perfusion scintigraphy. Intervention: Bilateral lung volume reduction surgery in the selected group. Measurements and results: Emphysema in patients selected for surgery was more severe overall and in the upper lungs by multiple QCT indexes (p < 0.01, unpaired two-tailed t test). Physiologic abnormalities were slightly more severe in selected patients (p < 0.05, unpaired two-tailed t test). The range of many QCT and physiologic values overlapped considerably between the selected and excluded groups. The percent severe emphysema (< - 960 Hounsfield units [HU]), upper/lower lung emphysema ratio (- 900 HU threshold), and residual volume were the key variables in the model predicting selection decisions (model r2 = 0.48; p < 0.0001). The model correctly predicted selection decisions in 87% of all cases, 91% of the selected group, and 78% of the excluded group. Surgical patients with a higher model-derived probability of selection had greater postoperative improvement in FEV1 and 6-min walk distance. Conclusions: Radiologic selection criteria are applied consistently to the majority of patients. QCT features are strongly associated with selection decisions, are related to outcome, and may help improve consistency and confidence in patient selection.
AB - Objectives: We used whole-lung quantitative CT analysis (QCT) - an objective method of evaluating emphysema severity and distribution based on measurement of lung density - to determine whether subjective selection criteria for lung volume reduction surgery are applied consistently and to model the patient selection process, and assessed the relationship of the model to postoperative outcome. Design: Logistic regression analysis using QCT indexes of emphysema and preoperative physiologic test results as the independent variables, and the decision to operate as the dependent variable. Setting: University hospital. Patients: Seventy patients selected for bilateral lung volume reduction surgery and 32 otherwise operable patients excluded from surgery based on subjective assessment of emphysema morphology on chest radiography, CT, and perfusion scintigraphy. Intervention: Bilateral lung volume reduction surgery in the selected group. Measurements and results: Emphysema in patients selected for surgery was more severe overall and in the upper lungs by multiple QCT indexes (p < 0.01, unpaired two-tailed t test). Physiologic abnormalities were slightly more severe in selected patients (p < 0.05, unpaired two-tailed t test). The range of many QCT and physiologic values overlapped considerably between the selected and excluded groups. The percent severe emphysema (< - 960 Hounsfield units [HU]), upper/lower lung emphysema ratio (- 900 HU threshold), and residual volume were the key variables in the model predicting selection decisions (model r2 = 0.48; p < 0.0001). The model correctly predicted selection decisions in 87% of all cases, 91% of the selected group, and 78% of the excluded group. Surgical patients with a higher model-derived probability of selection had greater postoperative improvement in FEV1 and 6-min walk distance. Conclusions: Radiologic selection criteria are applied consistently to the majority of patients. QCT features are strongly associated with selection decisions, are related to outcome, and may help improve consistency and confidence in patient selection.
KW - CT
KW - Emphysema
KW - Lung volume reduction surgery
UR - http://www.scopus.com/inward/record.url?scp=0034090572&partnerID=8YFLogxK
U2 - 10.1378/chest.117.4.991
DO - 10.1378/chest.117.4.991
M3 - Article
C2 - 10767229
AN - SCOPUS:0034090572
SN - 0012-3692
VL - 117
SP - 991
EP - 998
JO - CHEST
JF - CHEST
IS - 4
ER -