Pulmonary Pathology Online
Examination and Handling of Open Lung Biopsy Specimens
Open lung biopsy is an excellent diagnostic technique.
- Procedure of choice in the diagnosis and assessment of disease activity of diffuse lung disease.
- It has an important role in the management of solitary peripheral lesions in certain patients.
- It is useful in those conditions where morphological changes are too non-specific for diagnosis by a transbronchial specimen - Example: Cryptogenic fibrosing alveolitis / usual interstitial pneumonia, pulmonary vasculitides, autoimmune pulmonary disease, drug-induced changes and for pneumoconioses.
- Open lung biopsy is useful for the assessment of graft dysfunction after pediatric lung transplantation.
The lingula is commonly sampled but is suboptimal as deep alveolated lung is not represented and subpleural tissue often shows mild non-specific interstitial fibrosis.
Specimen Handling of Open Lung Biopsies:
- Biopsy size depends on whether the tissue is obtained by video-assisted thoracoscopy or exploratory thoracotomy (vary from 2 cm upwards).
- The tissue should always be handled very gently to prevent preoperative crushing, hemorrhage and polymorph infiltration.
- In all cases the pathologist should receive the tissue fresh and frozen section diagnosis may be requested.
- For optimal pathological assessment, open lung biopsies should be carefully inflated with formal saline using a fine caliber needle until the pleura is uniformly smooth and left immersed for 24 hours.
This helps in the histological assessment of the anatomical distribution of lesions, which is extremely important in the diagnosis of non-specific pulmonary conditions.
- Following fixation and transaction of the stapled margin, the biopsy is sectioned into 3-4 mm slices prior to processing.
- All specimens should be approached systematically.
Low power examination helps in the assessment of the anatomical distribution of pulmonary disease - (conducting airways ; blood vessels; alveoli ; interstitium, and pleura).
- In open lung biopsy 20 micron unstained sections can be used to assist in the identification of asbestos bodies.
The utility of open lung biopsy in patients with diffuse pulmonary infiltrates as related to respiratory distress, its impact on decision making by urgent intervention, and the diagnostic accuracy based on the biopsy location.
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