Wayne Max, Pilli Suchitra, Choi Hee Jae, Moulton Nathaniel, Chenna Praveen, Burks Allen Cole, Chen Alexander
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr, 3916K Taubman Center, Ann Arbor, MI 48109, USA.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University in St. Louis, St Louis, MO, USA.
Ther Adv Respir Dis. 2025 Jan-Dec;19:17534666251314724. doi: 10.1177/17534666251314724.
Bronchoscopic lung volume reduction (BLVR) can be an effective treatment for highly selected patients with severe emphysema but only half of carefully selected patients derive clinical benefit. Two commercially available platforms exist to help determine candidacy for BLVR via quantitative analysis of computed tomography (CT) scans.
To determine if the two commercially available quantitative platforms identified the same patient population that may benefit from BLVR.
A multicenter, retrospective cohort study.
Consecutive patients referred for BLVR between January 1, 2022 and March 31, 2023 at three medical centers in the United States with the same CT scan submitted for quantitative analysis to two commercially available platforms to determine BLVR candidacy were analyzed. The primary outcome of interest was whether quantitative analysis provided different recommendations for individual patients. The recommendation to proceed with BLVR was based on a prespecified algorithm using criteria established in clinical trials for each quantitative platform, respectively.
A total of 83 patients referred for BLVR across three centers were included; patients were a median 67 years old, had a median post bronchodilator FEV1 of 30% predicted (IQR: 25, 38), a median residual volume of 220% predicted (IQR: 185, 268), and 29 (34.9%) received endobronchial valves. A total of 26 patients (31.3%) received different recommendations from the two quantitative platforms.
In this cohort of patients evaluated for BLVR across multiple medical centers, nearly a third of patients received different recommendations based on the platform utilized for valve assessment. This suggests that the selection process for BLVR may warrant refinement.
支气管镜肺减容术（BLVR）对于经过严格筛选的重度肺气肿患者可能是一种有效的治疗方法，但只有一半经过精心挑选的患者能获得临床益处。有两种商用平台可通过计算机断层扫描（CT）扫描的定量分析来帮助确定BLVR的候选资格。
确定这两种商用定量平台所识别出的可能从BLVR中获益的患者群体是否相同。
一项多中心回顾性队列研究。
对2022年1月1日至2023年3月31日期间在美国三个医疗中心因BLVR前来就诊的连续患者进行分析，将相同的CT扫描结果提交给两个商用平台进行定量分析，以确定BLVR候选资格。感兴趣的主要结果是定量分析是否为个体患者提供了不同的建议。进行BLVR的建议分别基于使用每个定量平台在临床试验中确立的标准的预先指定算法。
三个中心共有83例因BLVR前来就诊的患者被纳入研究；患者的中位年龄为67岁，支气管扩张剂使用后FEV1的中位预测值为30%（四分位间距：25，38），残气量的中位预测值为220%（四分位间距：185，268），29例（34.9%）接受了支气管内瓣膜治疗。共有26例患者（31.3%）从两个定量平台获得了不同的建议。
在这个多中心接受BLVR评估的患者队列中，近三分之一的患者基于用于瓣膜评估的平台获得了不同的建议。这表明BLVR的选择过程可能需要改进。
