Lung wedge resection and lobectomy: Difference between revisions

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Mikael Häggström (talk | contribs)
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Mikael Häggström (talk | contribs)
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→Grossing: Moved
 
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==Intraoperative consultation==
==Intraoperative consultation==
Perform:
Perform:
*'''Tumor''' microscopy on frozen sectioning if there is intermediate risk of cancer.<ref group=notes>If frozen section does not show cancer, the surgeon may not need to perform lymph node dissection.
*'''Tumor''' microscopy on frozen sectioning if there is intermediate risk of cancer (if frozen section does not show cancer, the surgeon may not need to perform lymph node dissection)
*'''Margin''' assessment: A gross distance from tumor to the parenchymal is generally sufficient, unless a suspected malignancy is close enough to confer a significant risk of extension to the margin, in which case the closest parenchymal margin should be frozen {{en face}}. For '''lobectomies''', generally perform frozen section on the bronchial and vascular margin {{en face}}.
*'''Margin''' assessment: A gross distance from tumor to the parenchymal is generally sufficient, unless a suspected malignancy is close enough to confer a significant risk of extension to the margin, in which case the closest parenchymal margin should be frozen {{en face}}. For '''lobectomies''', generally perform frozen section on the bronchial and vascular margin {{en face}}.


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*Turn the specimen to the side with least cuts so far, and '''serially section''' it. Palpate for tumors intermittently.
*Turn the specimen to the side with least cuts so far, and '''serially section''' it. Palpate for tumors intermittently.
{|class=wikitable align=right
{|class=wikitable align=right
|+Initial measurements when<br> triaging fresh lobectomies<ref group=notes>When triaging a lobectomy for later grossing, measurements are most important as these may change after fixation. Other descriptions can be made upon tissue selection from the fixed specimen.</ref>
|+Initial measurements when<br> triaging fresh lobectomies
|
|
*Size of lobe in 3 dimenstions
*Size of lobe in 3 dimenstions
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[[File:Large cell carcinoma of the lung.jpg|thumb|'''Large cell carcinoma''', with a large multilobulated tumor adjacent to the hilum. A metastatically involved lymph node is present next to the bronchus.]]
[[File:Large cell carcinoma of the lung.jpg|thumb|'''Large cell carcinoma''', with a large multilobulated tumor adjacent to the hilum. A metastatically involved lymph node is present next to the bronchus.]]
</gallery>
</gallery>
{{Gross processing}}


==Microscopic evaluation==
==Microscopic evaluation==
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