Quantative computerized tomography assessment of lung density as a predictor of postoperative pulmonary morbidity in patients with lung cancer
Ataç, Gökçe Kaan
Sanhal, Ebru Ozan
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Background: The aim of this study was to evaluate the pulmonary reserve of the patients via preoperativequantitative computerized tomography (CT) and to determine if these preoperative quantitativemeasurements could predict the postoperative pulmonary morbidity.Methods: Fifty patients with lung cancer who underwent lobectomy/segmentectomy were included in thestudy. Preoperative quantitative CT scans and pulmonary function tests data were evaluated retrospectively.We compare these measurements with postoperative morbidity.Results: There were 32 males and 18 females with a mean age of 54.4±13.9 years. Mean total densitywas -790.6±73.4 HU. The volume of emphysematous lung was (<-900 HU) 885.2±1,378.4 cm3. Forcedexpiratory volume in one second (FEV1) (r=-0.494, P=0.02) and diffusion capacity of carbon monoxide(DLCO) (r=-0.643, P<0.001) were found to be correlate with the volume of emphysematous lung.Furthermore FEV1 (r=0.59, P<0.001) and DLCO (r=0.48, P<0.001) were also found to be correlate withmean lung density. Postoperative pulmonary morbidity was significantly higher in patients with lower lungdensity (P<0.001), larger volume of emphysema (P<0.001) and lower DLCO (P=0.039). A cut-off point of-787.5 HU for lung density showed 86.96% sensitivity and 81.48% specificity for predicting the pulmonarymorbidity (kappa =-0.68, P<0.001). Additionally a cut-off point of 5.41% for emphysematous volumeshowed 84.00% sensitivity and 80.00% specificity for predicting the pulmonary morbidity (kappa =0.64,P<0.001). According to logistic regression analyses emphysematous volume >5.41% (P=0.014) and lungdensity <-787.5 HU (P=0.009) were independent prognostic factors associated with postoperative pulmonarymorbidity.Conclusions: In this study, the patients with a lower lung density than -787.5 HU and a higher volumeof emphysema than 5.41% were found to be at increased risk for developing postoperative pulmonarymorbidity. More stringent precautions should be taken in those patients that were found to be at high risk toavoid pulmonary complications.