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Value of lung perfusion scintigraphy in predicting unresectability of patients with lung cancer and explorative thoracotomy

Nina Georgieva, George Kalaydjiev, Evelin Obretenov, Katya Peeva


Purpose: To determine the value of lung perfusion on predicting unresectability of lung carcinoma in patients with exploratory thoracotomy.

Materials and methods: We analyzed retrospectively the value of lung perfusion scintigraphy in 25 cases with primary lung carcinoma who had an exploratory thoracotomy (18 right and 7 left thoracotomy), regarding preoperative suggestion of unresectability. In most of these patients other noninvasive diagnostic methods (X-ray and CT) did not indicate inoperability.

Results: Only the perfusion lung scintigraphy demonstrated defects near the ipsilateral hilum and/or an enlargement of the mediastinum, displacement of mediastinum, displacement (pulling) of the hilum of the affected lung or a part of it to the mediastinum. At thoracotomy we found an involvement of hilar vessels and the mediastinum by the tumor or by `bulky` nodal metastases. Common peripheral concentric decrease of affected lung perfusion image dimensions, lacking or negligible perfusion of the affected lung also suggest inoperability. Perfusion indices at localization of the tumor in the right lung (15 of the patients) were mean=40,8%, SD=11,02%, SE=2,7%, and at localization in the left lung (6 of the patients) mean=36,27%, SD=10,60%, SE=4,01%.

Conclusion: These findings show that in some patients with bronchial carcinoma the perfusion scintigraphy image can suggest a potential unresectability and requires a more extensive staging like mediastinoscopy or thoracoscopy.


lung carcinoma; lung perfusion scintigraphy; explorative thoracotomy; operative contraindications

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About The Authors

Nina Georgieva
Trakia University of Stara Zagora

Department of Nuclear Medicine, Medical Faculty

George Kalaydjiev
Clinic of Thoracic Surgery National Oncology Hospital Sofia

Evelin Obretenov
Clinic of Thoracic Surgery University Hospital Stara Zagora

Katya Peeva


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