Lung Wedge Biopsy

Auto text: “Insert Lung Wedge Medical” or “Insert Lung Wedge Tumor”

Triage

All small resected pieces of lung (tumor wedges, pleural blebs, etc.) should be treated as open lung biopsies.

  1. If infectious disease is known or suspected and you need to open for frozen section, open the container and triage the specimen in the hood.
  2. Weigh and measure in 3 dimensions.
  3. Formalin fixation is appropriate if desired, especially in cases of TB.
  4. Others can be grossed same-day.

Gross

  1. For bullectomies and volume reduction (removal of blebs or bullae): Measure the wall thickness and size range of the dilated airspaces. Submit 2-3 representative cassettes.
  2. For medical lung disease: Serially section at 2 mm intervals and submit all tissue.
  3. For suspected infection in an immunocompromised host:  Serially section at 2 mm and submit the entire specimen.  If frozen section showed inflammatory lesion, on 2 sections that are the most grossly abnormal, order the following special stains up front: AFB (Ziehl Neelsen), GMS, and CMV (as appropriate).  Ensure that these cases are grossed and submitted the day of receipt! Request RUSH processing: Stamp requisition with “Priority” stamp, enter RUSH request into Vantage, and notify front desk.
  4. For neoplastic disease: Ink pleural surface black. Remove the staple line and ink lung parenchyma below staple line blue. Serially section perpendicular to staple line. Measure tumor in 3D, including distance to staple line and pleural surface. If greatest dimension is less than or equal to 1 cm, submit the whole tumor. If greatest dimension is larger than 1 cm, submit representative sections, at least 3 and no more than 6 sections (including frozen section, if performed). Submit sections demonstrating relationships with adjacent uninvolved parenchyma, staple line, and pleural surface. (NOTE: Tumor may have been banked prior to grossing – these measurements are of the fresh size before removal of tumor for tissue bank). Also submit at least two sections from uninvolved lung.
Print Friendly, PDF & Email