Accuracy and precision of perfusion lung scintigraphy versus Xe-radiospirometry for preoperative pulmonary functional assessment of patients with lung cancer

Purpose: This study sought to determine whether Xeradiospirometry (XRS) successfully selects patients able to undergo lung resection without postoperative respiratory complication and whether perfusion lung scintigraphy (PLS) is likely to provide a similar selection of patients for certain stages of the tumor. Methods: Two hundred and eightyfour patients with resectable lung cancer underwent preoperative assessment of postoperative forced expiratory volume in one second (FEV1) by XRS and PLS. Correlations, the Bland and Altman analysis and contingency tables were used to analyze the difference between the two predictive techniques. Results: One hundred and sixty patients underwent lung resection on the basis of XRS preoperative testing only. None of them developed respiratory insufficiency. Despite a close correlation, the limits of agreement between predicted FEV1 by XRS and PLS exceeded ± 0.3 L/s. For tumor stages T1Nx and T2N0, PLS underestimated postoperative FEV1 whereas it overestimated this parameter for stages III. Conclusion: The agreement between XRS and PLS is unacceptable, whereas XRS accurately selects patients able to undergo lung resection without postoperative pulmonary insufficiency. When only PLS is available, higher thresholds for patients with stage III cancers and lower thresholds for those with stage I cancers should be used to decide on operability.