Quantitative Perfusion Scintigraphy or Anatomic Segment Method in lung cancer resection

Our plain-English summary of Quantitative Perfusion Scintigraphy or Anatomic Segment Method in lung cancer resection, by T. Holvoet, J.P. van Meerbeeck, C. Van De Wiele, et al (Lung Cancer, 2011).

The study

• Authors: T. Holvoet, J.P. van Meerbeeck, C. Van De Wiele, B. Salhi, E. Derom
• Journal: Lung Cancer
• Published: 2011;74(2):212-8
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

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.

Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

In plain English

This retrospective cohort study from Ghent University, Belgium, compared two ways of predicting lung function after surgery for non-small cell lung cancer or mesothelioma: Quantitative Perfusion Scintigraphy (QPS), a lung scan, and the Anatomic Segment Method (ASM), a calculation based on how many lung segments are removed. It did not study asbestos exposure. Of 126 patients scanned between January 2003 and January 2010, 40 who had surgery and later lung tests were analysed (23 lobectomies, 14 pneumonectomies, 3 smaller resections). Both methods' predictions correlated similarly with lung function measured after surgery, and the two methods agreed closely with each other. On average both underestimated the air breathed out in one second (FEV1) after surgery, by 120 mL with QPS and 240 mL with ASM. ASM overestimated it in 8 patients and QPS in 13. The authors concluded that ASM may be as accurate as QPS and that QPS could be limited to patients whom ASM predicts cannot tolerate surgery, pending a large prospective trial. They listed the retrospective design and few patients with very low lung function as limitations.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective cohort study comparing two methods of predicting postoperative lung function
• Who was studied: 126 patients who had a perfusion scan as part of preoperative work-up for lung cancer (non-small cell lung cancer or mesothelioma) between January 2003 and January 2010 at a Department of Nuclear Medicine (authors at Ghent University Hospital, Belgium). 40 who had surgery and postoperative lung function tests were analysed: 23 lobectomies, 14 pneumonectomies, 3 lesser resections. The number of mesothelioma patients among the 40 is not stated.
• Exposure: No asbestos or fiber exposure was studied. The study compared two methods (QPS and ASM) of predicting lung function after resection.
• Main results:
  • In all 40 patients, predicted values correlated similarly with postoperative values. For FEV1 the correlation was 0.69 for QPS and 0.75 for ASM. For DL,CO (diffusing capacity) it was 0.70 for QPS and 0.74 for ASM.
  • Predictions from QPS and ASM correlated very highly with each other: 0.90 for both FEV1 and DL,CO in the article text.
  • In all cases, both methods underestimated actual postoperative FEV1 on average. QPS underestimated it by 120 mL (limits of agreement -0.67 to 0.92 L) and ASM by 240 mL (limits of agreement -0.51 to 0.99 L).
  • ASM predictions of FEV1 were on average 110 mL lower than QPS predictions. The limits of agreement between the two methods (-0.23 to 0.47 L) were narrower than those between either method and actual postoperative values.
  • ASM overestimated postoperative FEV1 in 8 cases and QPS in 13 cases. For DL,CO, ASM overestimated in 14 cases and QPS in 18 cases. The authors reported that the 8 ASM overestimations occurred in patients with exceptionally good lung function or who had an extrapleural pneumonectomy for mesothelioma (N = 3).
  • In the 18 patients with COPD, both methods correlated well with postoperative FEV1 (QPS 0.759; ASM 0.767). Correlation with postoperative DL,CO was poor for both methods (QPS 0.609; ASM 0.515).
  • Each scan cost 240 (the currency symbol is unreadable in the text). The authors calculated that avoiding the 31 scans they judged redundant, where ASM alone showed functional operability, would have saved 7440.
• The authors' conclusion: The authors concluded that ASM may be as accurate as QPS in predicting postoperative lung function and could be interchangeable with it. They considered ASM safer because it underestimates more. They suggested QPS could be limited to patients in whom ASM predicts functional inoperability, if supported by a large prospective trial, particularly in patients scheduled for pneumonectomy.
• Limitations the authors state:
  • Retrospective design
  • Patients excluded from surgery were not part of the study, so bias may have arisen
  • Small number of patients with particularly low lung function

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Lung Cancer, Mesothelioma, FEV1, COPD.

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