Prediction and intraoperative validation of pulmonary interlobar fissure development based on high-resolution...

Pulmonary interlobar fissure development is an important anatomical factor influencing the complexity of thoracoscopic pulmonary resection and surgical strategy selection. Accurate preoperative assessment of fissure completeness may facilitate operative planning and reduce intraoperative risks. This prospective diagnostic accuracy study aimed to evaluate the accuracy of high-resolution thin-slice computed tomography (HRCT) combined with multiplanar reconstruction (MPR) three-dimensional (3D) technology in predicting the development of pulmonary interlobar fissures, and to explore regional differences in predictive performance through intraoperative validation.

A total of 447 patients who underwent unilateral pulmonary surgery between September 2023 and April 2024 were enrolled. Preoperatively, three radiologists independently scored the development of operative-side interlobar fissures (divided into 5 segments: right horizontal fissure, upper/lower segments of right oblique fissure, and upper/lower segments of left oblique fissure) using HRCT and MPR images, with the average score as the preoperative result. Intraoperatively, three thoracic surgeons independently assessed the actual condition of the fissures, and the average score was recorded as the intraoperative result. The consistency between preoperative and intraoperative scores was analyzed using concordance rate, proportion of differences within 1 grade, and Kappa coefficient.

The overall concordance rate between preoperative and intraoperative scores was 55.42%, with 88.67% of cases showing a score difference within 1 grade (Kappa =0.48, P<0.01), indicating moderate agreement. Subgroup analysis revealed that the left lung had higher predictive accuracy than the right lung: the concordance rate was 59.54% vs. 52.87%, and the proportion of differences within 1 grade was 90.24% vs. 84.48% (left lung Kappa =0.556; right lung Kappa =0.437, both P<0.01). Among specific segments, the lower segment of the left oblique fissure exhibited the highest concordance rate (60.93%) and Kappa value (0.563), while the right horizontal fissure had the lowest concordance rate (52.59%) and Kappa value (0.414).

HRCT and MPR 3D reconstruction technology can effectively predict the development of pulmonary interlobar fissures, with superior accuracy in the left lung compared to the right lung. These findings provide valuable reference for preoperative planning of thoracic surgery, particularly in assessing complex fissure segments such as the right horizontal fissure.