Role of quantitative ventilation/perfusion scan (qVQ) in the pre-treatment assessment of bronchoscopic lung volume reduction with endobronchial valves (BLVR-EBV) for emphysema and the pre-operative assessment for lung cancer: a systematic review.

BACKGROUND: Quantitative ventilation/perfusion scan (qVQ) can assess differential lobar function and can guide management in bronchoscopic lung volume reduction with endobronchial valves (BLVR-EBV) and pre-operative assessment for lung resection for malignancy, but is not universally used clinically. Thus, for both indications we did a systematic review to evaluate qVQ: accuracy; proof of clinical value; and comparison with other imaging modalities. METHODS: We started a literature search from August 2025 in 4 databases: CENTRAL, MEDLINE, Embase, Emcare. We followed the PRISMA guidelines and prospectively registered with PROSPERO. The studies were assessed by three reviewers. RESULTS: A total of 1,756 abstracts were reviewed, 164 titles were selected for full text reviews. In total 40 full texts and 5 abstracts were included. We added our 2 recent publications and 2 other citations. For BLVR-EBV we found qVQ: target lobe (TL) choice is concordant with gold standard quantitative computed tomography (qCT); identifies altered lobar physiology post BLVR-EBV favouring the ipsilateral untreated lobe (IUL); has comparable results with quantitative functional CT (qFCT). For lung malignancy we found qVQ: accurately predicts post-operative pulmonary functional outcomes; has comparable results with other imaging modalities; has value in sub lobar resection and in radiotherapy. CONCLUSIONS: For BLVR-EBV and lung malignancy assessment, qVQ appears to be accurate; has value in guiding treatment decisions and prognostication; and is at least as accurate as other imaging techniques.