Gallium-68 perfusion positron emission tomography/computed tomography to assess pulmonary function in lung cancer patients undergoing surgery
AuthorLe Roux, P-Y; Leong, TL; Barnett, SA; Hicks, RJ; Callahan, J; Eu, P; Manser, R; Hofman, MS
Source TitleCancer Imaging
University of Melbourne Author/sHicks, Rodney; Barnett, Stephen; Hofman, Michael; Leong, Tracy Li-Tsein; Leong, Tracy Li-Tsein
AffiliationSurgery (Austin & Northern Health)
Medicine and Radiology
Document TypeJournal Article
CitationsLe Roux, P. -Y., Leong, T. L., Barnett, S. A., Hicks, R. J., Callahan, J., Eu, P., Manser, R. & Hofman, M. S. (2016). Gallium-68 perfusion positron emission tomography/computed tomography to assess pulmonary function in lung cancer patients undergoing surgery. CANCER IMAGING, 16 (1), https://doi.org/10.1186/s40644-016-0081-5.
Access StatusOpen Access
BACKGROUND: Pre-operative evaluation of lung cancer patients relies on calculation of predicted post-operative (PPO) lung function based on split lung function testing. Pulmonary perfusion (Q) PET/CT can now be performed by substituting Technetium-99 m labeling of macroaggregated albumin (MAA) with Gallium-68. This study compares Q PET/CT with current recommended methods of pre-operative lung function assessment. METHODS: Twenty-two patients planned for curative surgical resection (mean FEV1 77 %, SD 21 %; mean DLCO 66 %, SD 17 % predicted) underwent pre-operative Q PET/CT. Sixteen patients also underwent conventional lung scintigraphy. Lobar and lung split PPO lung function were calculated using Q PET/CT and current recommended methods, i.e. calculation based on anatomical segments for lobar function, and conventional perfusion scan for pneumonectomy. Bland-Altman statistics were used to calculate agreement between methods for PPO FEV1 and PPO DLCO. RESULTS: While mean split lobar functions were comparable, there was variation on an individual level between Q PET/CT and the anatomical method, with absolute difference over 5 % and 10 % in 37 % and 11 % of patients, respectively. For lobectomy the mean difference in PPO FEV1 was-1.2, but limits of agreement were-10 to 8.1 %. For DLCO, values were-1.1 % and-9.7 to 7.5 %, respectively. For pneumonectomy, PPO FEV1 values were-0.4 and-5.9 to 5.1 %. For DLCO, values were 0.3 % and-5.1 to 4.6 %. CONCLUSIONS: While anatomic estimation provides "fixed" results, split lobar functions computed with Q PET/CT vary widely, reflecting the intra and inter-individual variability of regional lung function. Further studies to assess the role of Q PET/CT in predicting peri-operative risk in lung cancer patients planned for lobectomy are warranted.
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