Advanced emphysema: Preoperative chest radiographic findings as predictorsof outcome following lung volume reduction surgery

PURPOSE: To determine whether preoperative chest radiographic findings alon e can reliably predict which patients will achieve the best functional outc ome of lung volume reduction surgery. MATERIALS AND METHODS: The preoperative chest radiographs obtained in 57 pa tients who had undergone lung volume reduction surgery were retrospectively scored by five blinded readers for severity and distribution of emphysema, evidence of lung compression, disease heterogeneity, and other features. C omparisons were made with the 3-6-month postoperative functional outcome fo r each patient. RESULTS: High disease heterogeneity (score >2) and unequivocal lung compres sion (score 1) both were 100% predictive of a favorable outcome (FEV1 incre ase, greater than or equal to 30%). Law heterogeneity (score <1) was 94% pr edictive of an unfavorable outcome (FEV1 increase <30%), as was a lack of l ung compression, which was 92% predictive of an unfavorable outcome. These two features also correlated with an improved 6-minute walk test result, al though this correlation was weaker. CONCLUSION: Chest radiography alone may be sufficient for initial screening . High disease heterogeneity and lung compression on chest radiographs are highly predictive of a favorable functional outcome.