title: Morphologic grading of emphysema is useful in the selection of candidates for unilateral or bilateral reduction pneumoplasty.
abstract: OBJECTIVE
  Radiologic morphology of emphysema proves useful in the selection of candidates for bilateral reduction pneumoplasty. We developed a simple morphologic grading system capable of identifying subsets of patients who had maximal functional improvement after unilateral or bilateral operation.
  
  
  METHODS
  Fifty-two patients who underwent unilateral (n=34) or bilateral (n=18) reduction pneumoplasty were evaluated. Emphysema morphology was visually scored by digital roentgenograms and high-resolution computed tomography. In each lung, severity of emphysema (ES), heterogeneity (DHT) and hyperinflation (DHF) degrees, were assessed. Asymmetric ratio of emphysema (ARE) between the lungs was expressed as: higher ES/lower ES scores. Morphometric data were correlated with absolute preoperative-postoperative FEV(1) change (DeltaFEV(1)).
  
  
  RESULTS
  No difference was found between the unilateral and the bilateral group for ES and DHT. DHF was greater in the bilateral group (3.1 vs. 2.7, P=0.02) whereas ARE was greater in the unilateral group (1.29 vs. 1. 05, P=0.0001). Stepwise logistic regression extracted as best predictors of maximal DeltaFEV(1), ARE (odds ratio=238, Wald test P=0.04) in the unilateral group, and DHT (odds ratio=24, P=0.03) in the bilateral group. Unilateral group DeltaFEV(1) was greater in patients with ARE>/=1.3 (0.44 vs. 0.24 l, P=0.02). Bilateral group DeltaFEV(1) was greater in patients with DHT>1 (0.50 vs. 0.31 l, P=0. 03). No difference was found when comparing DeltaFEV(1) resulting from unilateral RP and ARE>/=1.3, and bilateral RP (0.44 vs. 0.41 l, not significant).
  
  
  CONCLUSIONS
  This morphologic grading system identified subsets of patients who had maximal functional benefit from unilateral or bilateral reduction pneumoplasty and might be useful in the preoperative screening of candidates for either approach.
authors.affiliation: Department of Thoracic Surgery, Tor Vergata University, P. le Umanesimo 10, 00144, Rome, Italy. pompeo@med.uniroma2.it
authors.forename: E
authors.initials: E
authors.lastname: Pompeo
authors.forename: G
authors.initials: G
authors.lastname: Sergiacomi
authors.forename: I
authors.initials: I
authors.lastname: Nofroni
authors.forename: W
authors.initials: W
authors.lastname: Roscetti
authors.forename: G
authors.initials: G
authors.lastname: Simonetti
authors.forename: T C
authors.initials: TC
authors.lastname: Mineo
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018579:Patient Selection; D011013:Pneumonectomy / Q000379:methods*; D011237:Predictive Value of Tests; D011656:Pulmonary Emphysema / Q000145:classification* / Q000503:physiopathology / Q000601:surgery*; D015203:Reproducibility of Results; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome