title: Predicting Lung Volume Reduction after Endobronchial Valve Therapy Is Maximized Using a Combination of Diagnostic Tools.
abstract: BACKGROUND
  Bronchoscopic lung volume reduction using one-way endobronchial valves (EBVs) has been proven to be effective in patients with severe emphysema. However, the selection of patients without collateral ventilation prior to treatment is critical for procedural success. Collateral ventilation can be assessed directly with the Chartis system or indirectly using computed tomography (CT) fissure analysis.
  
  
  OBJECTIVE
  We retrospectively evaluated the diagnostic value of a combination of the quantitative CT interlobar fissure completeness score (FCS) and Chartis in predicting responders to EBV therapy.
  
  
  METHODS
  CT data from four prospective studies were pooled and analyzed using semiautomated software to quantify the completeness of interlobar fissures. These FCSs were compared to a reference standard of achieving ≥350 ml of target lobe volume reduction after EBV treatment. Using a receiver operating characteristic curve, optimal thresholds predictive of complete fissures (responders) and incomplete fissures (non-responders) were determined. A subgroup of patients with partially complete fissures was identified, where software had lower accuracy. The complementary value of Chartis was investigated in this group.
  
  
  RESULTS
  A fissure was defined as complete (FCS >95%), incomplete (FCS <80%), or partially complete (80% < FCS < 95%). The positive predictive value (PPV) of complete fissures is 88.1%, and the negative predictive value (NPV) is 92.9%, with an overall accuracy of 89.2%. Chartis was utilized in patients with partially complete fissures, with a PPV of 82.3%, an NPV of 84.6%, and an accuracy of 83.3%.
  
  
  CONCLUSIONS
  Combining diagnostic tools could reduce the burden on patients and the healthcare system while providing clinicians with a better means for patient selection for EBV therapy.
authors: Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors: T David
authors: TD
authors: Koster
authors: Eva M
authors: EM
authors: van Rikxoort
authors: Ralf-Harto
authors: RH
authors: Huebner
authors: Felix
authors: F
authors: Doellinger
authors: Karin
authors: K
authors: Klooster
authors: Jean-Paul
authors: JP
authors: Charbonnier
authors: Sri
authors: S
authors: Radhakrishnan
authors: Felix J F
authors: FJ
authors: Herth
authors: Dirk-Jan
authors: DJ
authors: Slebos
mesh_terms: D000368:Aged; D001999:Bronchoscopy; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D021621:Imaging, Three-Dimensional; D008168:Lung / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D019919:Prosthesis Implantation; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D012115:Residual Volume; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014109:Total Lung Capacity; D014797:Vital Capacity