2025 Volume 84 Issue 4 Pages 153-161
Preoperative assessment of chest wall invasion and intrathoracic adhesions in lung cancer surgery is crucial, as these factors significantly influence the choice of surgical procedure and the degree of intraoperative risk. This study investigated the clinical utility of dynamic chest radiography (DCR), a low-dose and simple imaging modality capable of capturing motion images, in the preoperative evaluation of chest wall involvement and in postoperative pulmonary function prediction. A total of 295 patients who underwent surgery for primary lung cancer at our institution between January 2022 and December 2023 were enrolled. The subjects were divided into two groups: Study 1 (n = 98), for preoperative adhesion prediction, and Study 2 (n = 31), for postoperative pulmonary function estimation. In Study 1, tumor movement on DCR was visually scored (0-2) and compared with intraoperative findings. When a score of 0 was defined as positive and a score of 2 was defined as negative, the results revealed a sensitivity of 84.6%, specificity of 95.4%, positive predictive value of 78.6%, and negative predictive value of 96.9%. A score of 1 was considered an indeterminate intermediate group requiring cautious interpretation. Tumor location and associated respiratory movement may also influence diagnostic accuracy. In Study 1, the maximum tumor diameter was 10.9 cm, the minimum was 0.8 cm, and the mean diameter was 3.4 cm. In Study 2, a significant positive correlation was found between diaphragm motion on DCR one year postsurgery and the ratio of postoperative to preoperative pulmonary function values (VC and FEV1.0), suggesting the potential of DCR as a predictor of postoperative respiratory capacity. These findings indicate that the DCR may serve as a convenient and effective tool for both preoperative evaluation and postoperative monitoring in patients undergoing lung cancer surgery.
