Bronchoscopic lung volume reduction: model for assisted target lobe selection.

IF 3.6 3区 医学 Q1 RESPIRATORY SYSTEM
Logan Hostetter, Leah M Brown, Srinivasan Rajagopalan, Megan M Dulohery-Scrodin, Eric S Edell, Michael G Lester, Fabien Maldonado, Robert Lentz, Brian J Bartholmai, Tobias Peikert
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引用次数: 0

Abstract

Introduction: Bronchoscopic lung volume reduction with endobronchial valves (EBV) is an effective procedure for patient with severe emphysema to improve lung function, exercise tolerance, dyspnoea and quality of life. Optimisation of patient and treatment lobe selection is essential for successful EBV outcomes. While clinical selection criteria are rigorous, many centres use a multidisciplinary team and rely on previous clinical experience for the selection process. To aid objective clinical decision making, we present a mathematical model to facilitate patient and target lobe selection.

Methods: A multidisciplinary team reviewed quantitative high-resolution computed tomography (HRCT) analysis from 119 patients to select candidates for EBV and to select a treatment lobe. Two logistic regression models, (1) candidacy for EBV placement and (2) target-lobe selection, were developed based on the normalised distributions of the four quantitative HRCT variables (fissure completeness score, per cent of voxel density with HU < -910 and HU < -950, and lobar volumes) across all five lung lobes. An external cohort of 50 patients (25 candidates and 25 non-candidates) was used to validate the prediction model.

Results: Performance measures of the training cohort demonstrated an area under the curve (AUC) of 0.91, accuracy of 81%, sensitivity of 93% and specificity of 78% compared with the multidisciplinary teams' target lobe selection. The validation cohort demonstrated an AUC of 0.89, accuracy of 84%, sensitivity of 88% and specificity of 83% compared with the multidisciplinary team decision making.

Conclusions: Endobronchial valve lung volume reduction remains a potent palliative measure to improve quality of life in patients with hyperinflated emphysema. Our model for target lobe selection harnesses the multidisciplinary experience at a tertiary care centre to objectively select candidates and target lobes to assist clinicians' decision making. Future studies investigating prediction of lobar collapse and functional improvement after target lobe selection using our model are needed.

支气管镜下肺减容:辅助靶肺选择模型。
支气管镜下支气管内瓣膜肺减容术(EBV)是重度肺气肿患者改善肺功能、运动耐量、呼吸困难和生活质量的有效方法。优化患者和治疗叶的选择对于成功的EBV预后至关重要。虽然临床选择标准是严格的,但许多中心使用多学科团队,并依靠以前的临床经验进行选择过程。为了帮助客观的临床决策,我们提出了一个数学模型,以方便患者和靶叶的选择。方法:一个多学科团队回顾了119例EBV患者的定量高分辨率计算机断层扫描(HRCT)分析,以选择EBV候选患者和选择治疗叶。两个逻辑回归模型(1)EBV放置候选性和(2)靶叶选择,基于四个定量HRCT变量(裂隙完整性评分,HU < -910和HU < -950的体素密度百分比,以及肺叶体积)在所有五个肺叶中的归一化分布而开发。采用50例患者(25例候选和25例非候选)的外部队列来验证预测模型。结果:与多学科团队的靶叶选择相比,训练队列的表现指标显示曲线下面积(AUC)为0.91,准确性为81%,灵敏度为93%,特异性为78%。与多学科团队决策相比,验证队列的AUC为0.89,准确性为84%,敏感性为88%,特异性为83%。结论:支气管瓣内肺减容仍然是一种有效的缓解措施,可以改善过度充气肺气肿患者的生活质量。我们的目标叶选择模型利用三级护理中心的多学科经验客观地选择候选人和目标叶,以帮助临床医生做出决策。未来的研究需要使用我们的模型来预测目标叶选择后的脑叶塌陷和功能改善。
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来源期刊
BMJ Open Respiratory Research
BMJ Open Respiratory Research RESPIRATORY SYSTEM-
CiteScore
6.60
自引率
2.40%
发文量
95
审稿时长
12 weeks
期刊介绍: BMJ Open Respiratory Research is a peer-reviewed, open access journal publishing respiratory and critical care medicine. It is the sister journal to Thorax and co-owned by the British Thoracic Society and BMJ. The journal focuses on robustness of methodology and scientific rigour with less emphasis on novelty or perceived impact. BMJ Open Respiratory Research operates a rapid review process, with continuous publication online, ensuring timely, up-to-date research is available worldwide. The journal publishes review articles and all research study types: Basic science including laboratory based experiments and animal models, Pilot studies or proof of concept, Observational studies, Study protocols, Registries, Clinical trials from phase I to multicentre randomised clinical trials, Systematic reviews and meta-analyses.
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