title: Fissure Integrity and Volume Reduction in Emphysema: A Retrospective Study.
abstract: BACKGROUND
  One-way endobronchial valves (EBVs) relieve symptoms of emphysema, particularly in patients without collateral ventilation between the target and adjacent lobes. Pretreatment knowledge of fissure integrity could serve as an aid in indicating EBV interventions.
  
  
  OBJECTIVE
  This study aimed to investigate the relationship between software-measured lung fissure integrity and clinically relevant lung volume reduction (≥350 ml) in emphysema patients treated with one-way EBVs using a lobar exclusion strategy.
  
  
  METHODS
  Of 108 patients treated between March 2008 and July 2014, 38 had both baseline and follow-up computed tomography (CT) scans acquired following a specific protocol for quantitative CT analysis and were included in the study (total of 39 treatments, two lungs treated in 1 patient). Outcome measures were fissure integrity measured on baseline CT scans, difference between pre- and postoperative lung volume (considering the lowest measured postoperative volume), and correlation between fissure integrity and volume change.
  
  
  RESULTS
  Fissure integrity ≥75% correlated with volume reduction ≥350 ml (Spearman coefficient: -0.65; p < 0.01). The mean and median volume reductions were 1,223.96 ± 907.5 ml and 663 ml, respectively, for lungs with fissure integrity ≥75% (n = 31). The accuracy of fissure integrity ≥75% in predicting a volume reduction was 87.2%. The positive predictive value of fissure integrity ≥75% to predict a volume reduction ≥350 ml was 83.9%, and it was 70% for fissure integrity 75-90% and 90.5% for fissure integrity >90%.
  
  
  CONCLUSIONS
  A target lobe volume reduction using EBVs is possible with lung fissure integrity ≥75%. For patients with fissure integrity between 75 and 90%, a further evaluation of interlobar ventilation should be performed. A clinically relevant volume reduction following treatment with EBVs is likely with any level of fissure integrity >90%.
authors.affiliation: Hospital Moinhos de Vento (HMV), Porto Alegre, Brazil.
authors.forename: Hugo Goulart
authors.initials: HG
authors.lastname: de Oliveira
authors.forename: Silvia Martins
authors.initials: SM
authors.lastname: de Oliveira
authors.forename: Rafael Ramos
authors.initials: RR
authors.lastname: Rambo
authors.forename: Amarilio Vieira
authors.initials: AV
authors.lastname: de Macedo Neto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy / Q000295:instrumentation*; D004646:Emphysema / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D012189:Retrospective Studies