Am. J. Respir. Crit. Care Med., Vol 151, No. 5, May 1995, 1373-1376.
Measurement of emphysema in autopsy lungs, with emphasis on interlobar differences
K Saito and WM Thurlbeck
Department of Pathology, University of British Columbia, Vancouver, Canada.
This study clarifies interlobar differences in the severity of emphysema
and examines the feasibility of assessing emphysema in a whole lung using
either the upper or lower lobes. Midsagittal, paper- mounted whole-lung
sections from 79 consecutive autopsies were used. The whole-lung sections
were scored by comparing them with the panel of standard pictures from
Grades 0 to 100, after which the upper or lower lobes were scored in the
same way but with the other lobe covered. Scores made on lobes and whole
lungs correlated significantly, but while projections to whole-lung scores
were quite accurate from the upper lobe, the projections from the lower
lobe were less precise. This was particularly true in patients with mild
emphysema. Individual lobes of the same lung sections were assessed by the
Ryder grid method. This analysis showed that emphysema was more severe in
the upper lobe of the 79 consecutive cases. The panel grading method showed
more severe emphysema in the upper lobe than in the lower lobe to a panel
score of 40; after this, the severity of emphysema in the two lobes was
similar. Scores made from the Ryder grid were very similar to those made
from the panel. Grading emphysema from one lobe, particularly the lower
lobe, is not appropriate if precise clinicopathologic correlations are
required.
