Lung perfusion scintigraphy in pulmonary carcinoma and pulmonectomy

PURPOSE: The surgical treatment is the most successful treatment of non-small cell lung cancer (NSCLC) in oncology practice. Lung perfusion scintigraphy as a non-invasive method for evaluation of the perfusion defect related to tumor localization in lung cancer patients is considered the differentiating line of pulmonary tests to predict post-operative lung function.MATERIALS AND METHODS: We analyzed retrospectively the value of lung perfusion scintigraphy in 10 cases with primary lung carcinoma who had a pulmonectomy (9 left and 1 right pulmonectomy).RESULTS: Changes in affected lung perfusion varied from impaired in different rate to perfusion defect in at least 3 lung segments (presented in 3 of the patients), 4 lung segments (present in 2 of the patients), or parts of segments, or defect affecting whole lobe. Impaired perfusion in a zone with polycyclic outlines in homolateral hilum was present in 7 of the patients. Perfusion indices at localization in the left lung (8 of the patients) were mean = 36,79%, SD=19,35%, SE=6,8%.CONCLUSION: Lung perfusion scintigraphy is a valuable method in the complex of pre-operative examinations to define the extent of the impairments in pulmonary perfusion and predicting the post-operative pulmonary function when pulmonectomy is about to be elaborated. The rate of perfusion changes and the percentage of involvement of the affected lung in the common pulmonary function correlate with survival. The low perfusion in the affected lung is not necessarily a contraindication for operative treatment

Pulmonary perfusion scintigraphy in lung carcinoma and lobectomy

PURPOSE: Most successful treatment of the lung cancer patients is the surgical resection. Lung perfusion scintigraphy is established method in the complex pre-operative diagnostics of lung carcinoma. It is used for selection of candidates for surgical treatment and in determination of operability and in decision on the operation volume.MATERIALS AND METHODS: We analyzed retrospectively the value of lung perfusion scintigraphy in 27 cases with primary lung carcinoma who had a lobectomy. Survival probability was calculated by Kaplan- Meier method. The log rank test was used to compare survival rates between groups.RESULTS: All patients with lobectomy were staged pre-operatively by noninvasive procedures at stages I-IIIA. The lung perfusion scintigraphy demonstrated an enlarged mediastinum at 1 of the patients. Impaired perfusion in homolateral hilum and in the contralateral hilum was found in some of the patients. Changes in affected lung perfusion varied from impaired in different rate to perfusion defect. Perfusion indices at affected lung have mean=48,59%. The survival of patients with Perfusion index less than 49% was mean = 56,333 months, and median = 35 months (3 years). The survival of patients with Perfusion index more than 49% was mean = 99,214 months, and median = 64 months (5.3 years). For I and II stage mean survival time was 120,727 months, and median survival time was 112 months (9.3 years). For IIIA and IIIB stage mean survival time was 48,667 months, and median survival time was 29 months (2,4 years).CONCLUSION: Lung perfusion scintigraphy is a valuable method in pre-operative diagnosis of lung carcinoma in determination of the extent of perfusion impairment in the affected lung and for determination of functional operability. Lobectomy is possible when perfusion in affected lung is over 41%, but the lower perfusion is not surely a contraindication for lobectomy. The extent of perfusion impairment is proportional to survival rate. Patients with lower perfusion impairments have more than 5 years median survival. In postoperative period perfusion scintigraphy shows re-distribution of perfusion in the healthy lung and in the rest of the operated lung. The survival of patients with lobectomy is corresponding to the clinical stage statistically significant

Value of lung perfusion scintigraphy in predicting unresectability of patients with lung cancer and explorative thoracotomy

Purpose: To determine the value of lung perfusion on predicting unresectability of lung carcinoma in patients with exploratory thoracotomy.Materials and methods: We analyzed retrospectively the value of lung perfusion scintigraphy in 25 cases with primary lung carcinoma who had an exploratory thoracotomy (18 right and 7 left thoracotomy), regarding preoperative suggestion of unresectability. In most of these patients other noninvasive diagnostic methods (X-ray and CT) did not indicate inoperability.Results: Only the perfusion lung scintigraphy demonstrated defects near the ipsilateral hilum and/or an enlargement of the mediastinum, displacement of mediastinum, displacement (pulling) of the hilum of the affected lung or a part of it to the mediastinum. At thoracotomy we found an involvement of hilar vessels and the mediastinum by the tumor or by `bulky` nodal metastases. Common peripheral concentric decrease of affected lung perfusion image dimensions, lacking or negligible perfusion of the affected lung also suggest inoperability. Perfusion indices at localization of the tumor in the right lung (15 of the patients) were mean=40,8%, SD=11,02%, SE=2,7%, and at localization in the left lung (6 of the patients) mean=36,27%, SD=10,60%, SE=4,01%.Conclusion: These findings show that in some patients with bronchial carcinoma the perfusion scintigraphy image can suggest a potential unresectability and requires a more extensive staging like mediastinoscopy or thoracoscopy

Lokalizacija i oblik stenoza u centralnom karcinomu pluća - osjetljivost i preciznost MDCT VB i FB

The objective is to present diagnostic capabilities of virtual bronchoscopy (VB) and fiberoptic bronchoscopy (FB) for determining the localization and shape of stenoses in patients with central lung carcinoma. A systematic study was performed on 220 patients aged 11-83 (54.36±17.24) years with endobronchial disease using the FB and VB methods during the 2013-2017 period. Central carcinoma of the lung was found on VB in 130 patients and on FB in 120 patients. Other nosologic diseases were found in 22 patients. Right localization of central carcinoma prevailed over left localization in both sexes. A significant difference in the localization criterion was found in female patients examined by VB (U-test, p=0.01). VB and FB yielded 86.5% vs. 91.60% precision and 85% vs. 94.5% sensitivity. In conclusion, VB was found to be a successful noninvasive method for determining the localization of lung tumors and shape of stenoses, which are essential in the diagnosis of malignant processes.Cilj je prikazati dijagnostičke mogućnosti virtualne bronhoskopije (VB) i fiberoptičke bronhoskopije (FB) za određivanje lokalizacije i oblika stenoze u bolesnika sa središnjim karcinomom pluća. Sustavna studija provedena je na 220 bolesnika u dobi od 11 do 83 godine (54,36±17,24) s endobronhijalnom bolesti primjenom metoda FB i VB u razdoblju od 2013. do 2017. godine. Središnji karcinom pluća otkriven je na VB u 130 bolesnika i na FB u 120 bolesnika. U 22 bolesnika pronađene su druge nozološke bolesti u oba spola. Desnostrana lokalizacija prevladavala je nad lijevostranom lokalizacijom središnjeg karcinoma. Značajna razlika u kriteriju lokalizacije pronađena je u žena koje su pregledane pomoću VB (U-test, p=0,01). Preciznost VB bila je 86,5% prema 91,60% za FB, dok je osjetljivost VB bila 85% u usporedbi s 94,5% za FB. Zaključeno je da je VB uspješna neinvazivna metoda za određivanje lokalizacije tumora pluća i oblika stenoza, koji su neophodni u dijagnostici zloćudnih procesa