Over the last decade, reorganisation of UK lung cancer services has led to a trebling in resection rate at our institution to about 25%. Combined with our high rate of lung cancer diagnosis and targets for rapid investigation and treatment this has dramatically increased the number of detailed lung function tests required. We examined spirometry, lung volumes and lung diffusion to determine whether certain low-risk individuals could be identified who could safely complete only spirometry before surgery
We examined detailed lung function in 235 people referred for testing, who were aged 40 years or older and had 10 or more years of cigarette smoking, to determine the number of surgical higher risk individuals identified by DLco and not by FEV1. We classified FEV1 and/or DLco <30% predicted as very high risk, <40% as high risk, <60% as moderate risk and 60% or greater as low risk
9/18 (50%) people identified as very high risk, 32/54 (59%) identified as high risk and 45/68 (66%) identified as moderate risk were only identified by DLco and not FEV1. 64/177 (36%) people identified as low risk using FEV1 were not low risk using DLco; including 19/177 (11%) high or very high risk individuals. No other measure, including FVC, FEV1/FVC, RV, IC and IC/TLC, appeared to better identify high risk people than DLco
In our population, DLco remains vital to identify people who are higher risk for lung cancer resection and cannot be replaced by simpler lung function measurements.