Application of 3D Digital Lung Software in Preoperative Planning of Patients with Mul-tiple Pulmonary Nodules and Poor Pulmonary Function_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 LIZhong ¹ , YANGQing-jie ² , HUANGXiao-yang ³ , HUMeng ² , BAOChuan-en ² , HUANGXiao-mei ² , GUOMing ²

1. Department of Cardiothoracic Surgery, PLA 174th Clinical College of Anhui Medical University, Xiamen 361000 Fujian, P. R. China;
2. Department of Cardiothoracic Surgery, The Success Hospital Affiliated Xiamen University, Xiamen 361000 Fujian, P. R. China;
3. Xiamen QiangBen Science and Technology Company, Xiamen 361000 Fujian, P. R. China;

Corresponding author：

LIZhong, Email: 568214188@qq.com

Keywords：

Three-dimensional; Location; Pulmonary segment; Pulmonary nodule; Preoperative planning

DOI：

10.7507/1007-4848.20160255

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Objective To assess the feasibility of 3D digital lung software used in preoperative planning of patients with multiple pulmonary nodules and poor pulmonary function. Methods Five patients with multiple pulmonary nodules in the left lung, meanwhile with a history of single lung lobectomy in the right lung were included in our hospital between June and December 2015. There were 4 males and 1 female at an average age of 50.4±2.6 years. A 320-slice volumetric CT scanner was used to the CT angiography (CTA) of the pulmonary artery. The data of CT images were imported into the 3D digital lung software that was researched and developed by Xiamen QiangBen Science and Technology Company. The 3D reconstruction of digital virtual lung was completed by this software based on those data. At the same time the soft-ware completed the automatic segmentation of the lung based on the pulmonary artery system and the 3D reconstruction of the pulmonary nodules. The 3D digital lung software calculated the volume proportion of the intended removal (segm-ental lesions) to the whole lung, estimated the effect of surgery on forced expired volume in one second (FEV₁), and the patient's tolerance ability to surgery. After the preoperative planning, the patients received multiple pulmonary segmental/subsegmental resection under the general anesthesia by video-assisted thoracoscopic surgery (VATS). Results The 3d reconstruction of the pulmonary arteries reached 5 levels in 5 patients. And the software automatically identified out the lung segment/subsegment to show the lung nodules of lung segment/subsegment. The preselection lung volume of 5 patients accounted for 14.00%-27.00% of total lung volume. The software estimated FEV₁ as 1.16-1.46 L which can tolerate the operation. The 5 patients were successfully performed surgery of multiple pulmonary segmental/subsegmental resection under the general anesthesia by VATS. The software located lung nodules from the resection of pulmonary segments during operation immediately. Then we sent them to the rapid pathological examination for diagnosis. After operation, the patients recovered well, and had no respiratory insufficiency. Hospitalization day was 4 days. Conclusion The 3D digital pulmonary software can not only automatically identify the pulmonary segments, precisely position the pulmonary nodule, show the relationship among the target pulmonary segments artery, vein, bronchus and the surroun-ding artery, vein, and bronchus, but also calculate the volume of the pulmonary segments, estimate the impact of the pulmonary segmentectomy on the FEV₁. It is useful for precise evaluation of the tolerant capacity of multiple pulmonary nodules in patients with unstaged multiple pulmonary segments.

Citation： LIZhong, YANGQing-jie, HUANGXiao-yang, HUMeng, BAOChuan-en, HUANGXiao-mei, GUOMing. Application of 3D Digital Lung Software in Preoperative Planning of Patients with Mul-tiple Pulmonary Nodules and Poor Pulmonary Function. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(11): 1086-1091. doi: 10.7507/1007-4848.20160255 Copy

1.	Schuchert MJ, Pettiford BL, Keeley S. Anatomic segmentectomy in the treatment of stage I non-small cell lung cancer. Ann Thorac Surg, 2007, 84(3): 926-932.
2.	Wahidi MM, Govert JA, Goudar RK, et al. Evidence for the treat-ment of patients with pulmonary nodules: when is it lung cancer? ACCP evidence-based clinical practice guidelines (2nd edition). Chest, 2007, 132(3 Suppl): 94s-107s.
3.	Gomez-Saez N, Gonzalez-Alvarez I, Vilar J, et al. Prevalence and variables associated with solitary pulmonary nodules in a routine clinic-based population: a cross-sectional study. Eur Radiol, 2014, 24(9): 2174-2182.
4.	Shi CZ, Zhao Q, Luo LP, et al. Size of solitary pulmonary nodule was the risk factor of malignancy. J Thorac Dis, 2014, 6(6): 668-676.
5.	严四军, 曹祥, 邓波荣, 等.恶性肺小结节的危险因素分析及预测模型的建立.中国胸心血管外科临床杂志, 2013, 20(4): 441-445.
6.	刘明, 姜格宁.孤立性肺结节的良恶性鉴别及处理策略.中国胸心血管外科临床杂志, 2014, 21(1): 102-106.
7.	奚小祥, 吕必宏, 何光明, 等.孤立性肺结节早期诊治的临床策略.中国胸心血管外科临床杂志, 2014, 21(6): 793-799.
8.	Zeiher BG, Gross TJ, Kern JA, et al. Predicting postoperative pulmonary function in patients undergoing lung resection. Chest, 1995, 108(1): 68-72.
9.	Kearney DJ, Lee TH, Reilly JJ, et al. Assessment of operative risk in patients undergoing lung resection. Chest, 1994, 105(3): 753-759.
10.	Miller JI, Hatcher CR. Limited resection of bronchogenic carcinoma in the patient with marked impairment of pulmonary function. Ann Thorac Surg, 1987, 44(4): 340-343.
11.	Markos J, Nakahara K, Ohno K, et al. Preoperative assessment as a predictor of mortality and morbidity after lung resection. Am Rev Respir Dis, 1989, 139(4): 902-910.

1. Schuchert MJ, Pettiford BL, Keeley S. Anatomic segmentectomy in the treatment of stage I non-small cell lung cancer. Ann Thorac Surg, 2007, 84(3): 926-932.
2. Wahidi MM, Govert JA, Goudar RK, et al. Evidence for the treat-ment of patients with pulmonary nodules: when is it lung cancer? ACCP evidence-based clinical practice guidelines (2nd edition). Chest, 2007, 132(3 Suppl): 94s-107s.
3. Gomez-Saez N, Gonzalez-Alvarez I, Vilar J, et al. Prevalence and variables associated with solitary pulmonary nodules in a routine clinic-based population: a cross-sectional study. Eur Radiol, 2014, 24(9): 2174-2182.
4. Shi CZ, Zhao Q, Luo LP, et al. Size of solitary pulmonary nodule was the risk factor of malignancy. J Thorac Dis, 2014, 6(6): 668-676.
5. 严四军, 曹祥, 邓波荣, 等.恶性肺小结节的危险因素分析及预测模型的建立.中国胸心血管外科临床杂志, 2013, 20(4): 441-445.
6. 刘明, 姜格宁.孤立性肺结节的良恶性鉴别及处理策略.中国胸心血管外科临床杂志, 2014, 21(1): 102-106.
7. 奚小祥, 吕必宏, 何光明, 等.孤立性肺结节早期诊治的临床策略.中国胸心血管外科临床杂志, 2014, 21(6): 793-799.
8. Zeiher BG, Gross TJ, Kern JA, et al. Predicting postoperative pulmonary function in patients undergoing lung resection. Chest, 1995, 108(1): 68-72.
9. Kearney DJ, Lee TH, Reilly JJ, et al. Assessment of operative risk in patients undergoing lung resection. Chest, 1994, 105(3): 753-759.
10. Miller JI, Hatcher CR. Limited resection of bronchogenic carcinoma in the patient with marked impairment of pulmonary function. Ann Thorac Surg, 1987, 44(4): 340-343.
11. Markos J, Nakahara K, Ohno K, et al. Preoperative assessment as a predictor of mortality and morbidity after lung resection. Am Rev Respir Dis, 1989, 139(4): 902-910.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of 3D Digital Lung Software in Preoperative Planning of Patients with Mul-tiple Pulmonary Nodules and Poor Pulmonary Function

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