title: Quantative computerized tomography assessment of lung density as a predictor of postoperative pulmonary morbidity in patients with lung cancer.
abstract: BACKGROUND
  The aim of this study was to evaluate the pulmonary reserve of the patients via preoperative quantitative computerized tomography (CT) and to determine if these preoperative quantitative measurements could predict the postoperative pulmonary morbidity.
  
  
  METHODS
  Fifty patients with lung cancer who underwent lobectomy/segmentectomy were included in the study. Preoperative quantitative CT scans and pulmonary function tests data were evaluated retrospectively. We compare these measurements with postoperative morbidity.
  
  
  RESULTS
  There were 32 males and 18 females with a mean age of 54.4±13.9 years. Mean total density was -790.6±73.4 HU. The volume of emphysematous lung was (<-900 HU) 885.2±1,378.4 cm(3). Forced expiratory volume in one second (FEV1) (r=-0.494, P=0.02) and diffusion capacity of carbon monoxide (DLCO) (r=-0.643, P<0.001) were found to be correlate with the volume of emphysematous lung. Furthermore FEV1 (r=0.59, P<0.001) and DLCO (r=0.48, P<0.001) were also found to be correlate with mean lung density. Postoperative pulmonary morbidity was significantly higher in patients with lower lung density (P<0.001), larger volume of emphysema (P<0.001) and lower DLCO (P=0.039). A cut-off point of -787.5 HU for lung density showed 86.96% sensitivity and 81.48% specificity for predicting the pulmonary morbidity (kappa =-0.68, P<0.001). Additionally a cut-off point of 5.41% for emphysematous volume showed 84.00% sensitivity and 80.00% specificity for predicting the pulmonary morbidity (kappa =0.64, P<0.001). According to logistic regression analyses emphysematous volume >5.41% (P=0.014) and lung density <-787.5 HU (P=0.009) were independent prognostic factors associated with postoperative pulmonary morbidity.
  
  
  CONCLUSIONS
  In this study, the patients with a lower lung density than -787.5 HU and a higher volume of emphysema than 5.41% were found to be at increased risk for developing postoperative pulmonary morbidity. More stringent precautions should be taken in those patients that were found to be at high risk to avoid pulmonary complications.
authors.affiliation: 1 Department of Thoracic Surgery, 2 Department of Radiology, Ufuk University School of Medicine, Ankara, Turkey ; 3 Department of Thoracic Surgery, Kirikkale University School of Medicine, Kirikkale, Turkey ; 4 Department of Thoracic Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey ; 5 Department of Statistics, Ufuk University Faculty of Art and Science, Ankara, Turkey ; 6 Department of Thoracic Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Tevfik
authors.initials: T
authors.lastname: Kaplan
authors.affiliation: 1 Department of Thoracic Surgery, 2 Department of Radiology, Ufuk University School of Medicine, Ankara, Turkey ; 3 Department of Thoracic Surgery, Kirikkale University School of Medicine, Kirikkale, Turkey ; 4 Department of Thoracic Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey ; 5 Department of Statistics, Ufuk University Faculty of Art and Science, Ankara, Turkey ; 6 Department of Thoracic Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Gokce Kaan
authors.initials: GK
authors.lastname: Atac
authors.affiliation: 1 Department of Thoracic Surgery, 2 Department of Radiology, Ufuk University School of Medicine, Ankara, Turkey ; 3 Department of Thoracic Surgery, Kirikkale University School of Medicine, Kirikkale, Turkey ; 4 Department of Thoracic Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey ; 5 Department of Statistics, Ufuk University Faculty of Art and Science, Ankara, Turkey ; 6 Department of Thoracic Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Nesimi
authors.initials: N
authors.lastname: Gunal
authors.affiliation: 1 Department of Thoracic Surgery, 2 Department of Radiology, Ufuk University School of Medicine, Ankara, Turkey ; 3 Department of Thoracic Surgery, Kirikkale University School of Medicine, Kirikkale, Turkey ; 4 Department of Thoracic Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey ; 5 Department of Statistics, Ufuk University Faculty of Art and Science, Ankara, Turkey ; 6 Department of Thoracic Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Bulent
authors.initials: B
authors.lastname: Kocer
authors.affiliation: 1 Department of Thoracic Surgery, 2 Department of Radiology, Ufuk University School of Medicine, Ankara, Turkey ; 3 Department of Thoracic Surgery, Kirikkale University School of Medicine, Kirikkale, Turkey ; 4 Department of Thoracic Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey ; 5 Department of Statistics, Ufuk University Faculty of Art and Science, Ankara, Turkey ; 6 Department of Thoracic Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Aslıhan
authors.initials: A
authors.lastname: Alhan
authors.affiliation: 1 Department of Thoracic Surgery, 2 Department of Radiology, Ufuk University School of Medicine, Ankara, Turkey ; 3 Department of Thoracic Surgery, Kirikkale University School of Medicine, Kirikkale, Turkey ; 4 Department of Thoracic Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey ; 5 Department of Statistics, Ufuk University Faculty of Art and Science, Ankara, Turkey ; 6 Department of Thoracic Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Sezai
authors.initials: S
authors.lastname: Cubuk
authors.affiliation: 1 Department of Thoracic Surgery, 2 Department of Radiology, Ufuk University School of Medicine, Ankara, Turkey ; 3 Department of Thoracic Surgery, Kirikkale University School of Medicine, Kirikkale, Turkey ; 4 Department of Thoracic Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey ; 5 Department of Statistics, Ufuk University Faculty of Art and Science, Ankara, Turkey ; 6 Department of Thoracic Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Yucel
authors.affiliation: 1 Department of Thoracic Surgery, 2 Department of Radiology, Ufuk University School of Medicine, Ankara, Turkey ; 3 Department of Thoracic Surgery, Kirikkale University School of Medicine, Kirikkale, Turkey ; 4 Department of Thoracic Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey ; 5 Department of Statistics, Ufuk University Faculty of Art and Science, Ankara, Turkey ; 6 Department of Thoracic Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Ebru Ozan
authors.initials: EO
authors.lastname: Sanhal
authors.affiliation: 1 Department of Thoracic Surgery, 2 Department of Radiology, Ufuk University School of Medicine, Ankara, Turkey ; 3 Department of Thoracic Surgery, Kirikkale University School of Medicine, Kirikkale, Turkey ; 4 Department of Thoracic Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey ; 5 Department of Statistics, Ufuk University Faculty of Art and Science, Ankara, Turkey ; 6 Department of Thoracic Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Koray
authors.initials: K
authors.lastname: Dural
authors.affiliation: 1 Department of Thoracic Surgery, 2 Department of Radiology, Ufuk University School of Medicine, Ankara, Turkey ; 3 Department of Thoracic Surgery, Kirikkale University School of Medicine, Kirikkale, Turkey ; 4 Department of Thoracic Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey ; 5 Department of Statistics, Ufuk University Faculty of Art and Science, Ankara, Turkey ; 6 Department of Thoracic Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Serdar
authors.initials: S
authors.lastname: Han
keywords: Preoperative care; complications; emphysema; lung cancer surgery; surgery