Pulmonary perfusion scintigraphy in lung carcinoma and lobectomy

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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.