Quantitative Perfusion Scintigraphy or Anatomic Segment Method in lung cancer resection.

BACKGROUND

Quantitative Perfusion Scintigraphy (QPS) and Anatomic Segment Method (ASM) are two techniques for estimating postoperative pulmonary function. QPS is gold standard, but holds disadvantages.

AIM

Could ASM substitute QPS in the preoperative work-up of NSCLC?

METHODS

Retrospective study in patients with NSCLC or mesothelioma undergoing resection. FEV1 and DL,CO were estimated by QPS and ASM and compared to pulmonary function measured 3 months after resection. Correlation tests and Bland-Altman analyses were performed.

RESULTS

40 patients (23 lobectomies, 14 pneumonectomies). Both methods correlated similarly with postoperative FEV(1) (QPSρ=0.69; ASMρ=0.75) and DL,CO (QPSρ=0.70; ASMρ=0.74). Correlation between both methods was high (ppoFEV(1)ρ=0.89; ppoDL,COρ=0.89). The same principles applied in a subgroup analysis of patients with COPD. Bland-Altman analyses showed that ASM underestimated postoperative FEV(1) and DL,CO more than QPS in all groups.

CONCLUSION

QPS and ASM are remarkably similar in predicting postoperative pulmonary function. As ASM underestimates pulmonary function more, it could be a safe alternative from a cost-benefit point of view. Based on these results, it appears that QPS could be restricted to patients in whom ASM suggests functional inoperability, although further prospective studies are necessary.