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CT-defined visual emphysema in smokers with normal spirometry: association with prolonged air leak and other respiratory complications after lobectomy for lung cancer

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Abstract 

Objectives

To evaluate the association of visual emphysema on preoperative CT with respiratory complications and prolonged air leak (PAL) in smokers with normal spirometry who underwent lobectomy for lung cancer.

Methods

Among patients who underwent lobectomy for lung cancer between 2018 and 2019 at a single center, ever-smokers with normal spirometry were identified retrospectively. Visual emphysema was graded for centrilobular emphysema (CLE) and paraseptal emphysema (PSE), respectively, by two thoracic radiologists. The associations of visual emphysema with PAL and respiratory complications (except PAL) were investigated.

Results

In total, 282 patients were evaluated (257 men; mean age, 64.6 ± 9.8 years). Visual emphysema was present in 126 patients (44.7%) (CLE, 26; PSE, 40; combined CLE and PSE, 60). PAL and respiratory complications occurred in 34 (12.1%) and 26 patients (26.9%), respectively. Greater frequency of PAL and respiratory complications were observed in patients with higher grades of CLE (p = 0.002 for PAL; p = 0.039 for respiratory complications) and PSE (p < 0.001 for PAL; p < 0.001 for respiratory complications). For reader 1 evaluation, the presence of both CLE and PSE was associated with PAL (adjusted odds ratio [OR], 4.94; 95% confidence interval [CI], 1.75–13.95; p = 0.003). For reader 2 evaluation, PSE (adjusted OR, 4.26; 95% CI, 1.22–14.97; p = 0.024) and combined CLE and PSE (adjusted OR, 3.49; 95% CI, 12.1–10.06; p = 0.020) were associated with PAL. The presence of solely CLE was not associated with any adverse outcome (all p > 0.05) for both readers.

Conclusions

Visual assessment of PSE in smokers with normal spirometry may help identify those who develop PAL after lobectomy.

Key Points

• Visual emphysema was highly prevalent (44.7%) in smokers with normal lung function who underwent lobectomy for lung cancer.

• Increasing tendency of postoperative complications was observed as the grade of visual emphysema increased.

• The presence of paraseptal emphysema was associated with prolonged air leak.

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Abbreviations

CI:

Confidence interval

CLE:

Centrilobular emphysema

COPD:

Chronic obstructive pulmonary disease

CT:

Computed tomography

DLCO :

Diffusing capacity for carbon monoxide

FEV1 :

Forced expiratory volume in 1 s

FVC:

Forced vital capacity

OR:

Odds ratio

PAL:

Prolonged air leak

PFT:

Pulmonary function test

PSE:

Paraseptal emphysema

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The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Taeyoung Yun, Kwon Joong Na, Samina Park, In Kyu Park, Chang Hyun Kang & Young Tae Kim

  2. Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea

    Hyewon Choi

  3. Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Hyungjin Kim & Jin Mo Goo

  4. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea

    Young Tae Kim

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  1. Taeyoung Yun
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Corresponding authors

Correspondence to Hyungjin Kim or Kwon Joong Na.

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Ethical approval

Institutional Review Board approval was obtained (Approval No. H-2103–078-1204; approval date March 16, 2021).

Guarantor

The scientific guarantor of this publication is Kwon Joong Na.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board (Approval No. H-2103–078-1204; approval date March 16, 2021).

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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• Retrospective

• Observational

• Performed at one institution

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Taeyoung Yun and Hyewon Choi contributed equally

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Yun, T., Choi, H., Kim, H. et al. CT-defined visual emphysema in smokers with normal spirometry: association with prolonged air leak and other respiratory complications after lobectomy for lung cancer. Eur Radiol 32, 4395–4404 (2022). https://doi.org/10.1007/s00330-022-08540-w

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