Am. J. Respir. Crit. Care Med., Volume 163, Number 5, April 2001, 1068-1073

Comparison of Physiological and Radiological Screening for Lung Volume Reduction Surgery

EDWARD P. INGENITO, STEPHEN H. LORING, MARILYN L. MOY, STEVEN J. MENTZER, SCOTT J. SWANSON, ANDETTA HUNSAKER, CHARLOTTE C. MCKEE, and JOHN J. REILLY

Departments of Pulmonary and Critical Care Medicine, Radiology, and Thoracic Surgery, Brigham and Women's Hospital; and Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts

Physiological and radiological criteria are both used to identify candidates for LVRS. This study compares the predictive value of these screening techniques among patients with homogeneous (Ho) and heterogeneous (He) emphysema. Preoperative inspiratory lung conductance (G_Li) during spontaneous breathing and quantitative radioisotope / scan (QVQS) results were available for 48 of 50 patients undergoing bilateral LVRS for emphysema. Ho disease (n = 21) was defined by QVQS as an upper/lower perfusion ratio (ULPR) between 0.75 and1.25. G_Li correlated with 6-mo improvement in FEV₁ (FEV₁-6) (r = 0.53, p < 0.001) for the entire cohort, and for patients with both Ho (n = 21, r = 0.56, p = 0.015) and He disease (n = 27, r = 0.46, p = 0.017). ULPR correlated less well with FEV₁-6 (n = 48, r = 0.38; p = 0.008) for the cohort, and was significantly correlated with outcomes only in the subgroup of patients with He disease (r = 0.40, p = 0.04). Multivariate regression demonstrated that by combining G_Li and ULPR criteria, 33% of the FEV₁-6 response could be accounted for. We conclude that both physiological and radiological criteria help identify appropriate candidates for LVRS. G_Li best identifies patients with Ho emphysema who may benefit from surgery, but would be excluded on the basis of strictly radiological criteria. ULPR helps identify patients with He disease that improves with surgery, despite unfavorable G_Li.

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