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Bronchoscopic lung volume reduction: model for assisted target lobe selection.

Logan Hostetter¹, Leah M Brown², Srinivasan Rajagopalan³

¹Department of Internal Medicine, Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, Minnesota, USA.

BMJ Open Respiratory Research

|June 5, 2025

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A new mathematical model aids in selecting patients and target lobes for endobronchial valve (EBV) lung volume reduction, improving outcomes for severe emphysema. This objective approach enhances clinical decision-making for this potent palliative procedure.

Area of Science:

Pulmonary Medicine
Medical Imaging
Biostatistics

Background:

Bronchoscopic lung volume reduction using endobronchial valves (EBV) effectively treats severe emphysema, improving lung function and quality of life.
Optimal patient and treatment lobe selection are critical for successful EBV outcomes, often relying on multidisciplinary teams and clinical experience.

Purpose of the Study:

To develop and validate a mathematical model for objective patient and target lobe selection for EBV procedures.
To assist clinicians in making informed decisions for EBV therapy.

Main Methods:

Quantitative high-resolution computed tomography (HRCT) analysis from 119 patients was used to develop two logistic regression models for EBV candidacy and target lobe selection.
Models were based on normalized HRCT variables: fissure completeness, voxel density (HU < -910, HU < -950), and lobar volumes.

Keywords:

Bronchoscopy Emphysema Lung Volume Reduction Surgery

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A separate cohort of 50 patients validated the predictive model.

Main Results:

The training cohort showed high performance with an AUC of 0.91, 81% accuracy, 93% sensitivity, and 78% specificity.
The validation cohort demonstrated strong results with an AUC of 0.89, 84% accuracy, 88% sensitivity, and 83% specificity.
The model's predictions closely aligned with multidisciplinary team decisions.

Conclusions:

Endobronchial valve lung volume reduction is a powerful palliative treatment for hyperinflated emphysema.
The developed mathematical model objectively aids in selecting candidates and target lobes, leveraging multidisciplinary expertise.
Future research should explore the model's utility in predicting lobar collapse and functional improvements post-treatment.