Lung wedge resection and lobectomy: Difference between revisions
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{{Comprehensiveness}} | |||
==Grossing== | ==Grossing== | ||
[[File:Gross pathology of surgical margin sampling in lobectomy.jpg|thumb|Surgical margin sampling of a lobectomy for intraoperative consultation.]] | [[File:Gross pathology of surgical margin sampling in lobectomy.jpg|thumb|Surgical margin sampling of a lobectomy for intraoperative consultation.]] | ||
Perform the following:<ref>Partially using the following procedure:{{cite web|url=https://www.uclahealth.org/pathology/workfiles/Education/Residency%20Program/Gross%20Manual/Wedge%20Resection.pdf|title=Pulmonary pathology grossing guidelines|accessdate=2021-03-17}}</ref> | |||
Perform the following:<ref>{{cite web|url=https://www.uclahealth.org/pathology/workfiles/Education/Residency%20Program/Gross%20Manual/Wedge%20Resection.pdf|title=Pulmonary pathology grossing guidelines|accessdate=2021-03-17}}</ref> | |||
*'''Measure''' the specimen in 3 dimensions. | *'''Measure''' the specimen in 3 dimensions. | ||
*Describe '''pleural surface''', including color, and any presence of granularity, adhesions, retraction, or tumor. | *Describe '''pleural surface''', including color, and any presence of granularity, adhesions, retraction, or tumor. | ||
* | *'''Palpate''' for any tumors. | ||
*[[Ink]] the '''surgical margin''' and cut it away just below any sutures or staples. If the margin is substantially stapled (and their removal would be either too tissue-damaging or otherwise inconvenient), ink and use another section of the tissue underneath it for frozen sectioning. | |||
:*In '''intraoperative consultations''' use a section that is presumably closest to a tumor for [[frozen sectioning]], with the tissue [[enface]], for radicality. This is generally enough to report to the surgeon, unless otherwise requested. | |||
*{{Comprehensive-begin}}Sample the entire surgical margin for standard processing.{{Comprehensive-end}} | |||
*Cut open the '''bronchi''' of the specimen with a pair of scissors, as far as they can fit within the lumina. Attempt to cut so as to be able to take a section that includes both any tumor and nearest bronchus. Describe the cut surface, including color and consistency, and any focal lesions. | |||
*Turn the specimen to the side with least cuts so far, and '''serially section''' it. | |||
*For any found '''[[lung tumor]]''': | |||
:*Measure '''tumor size''' as a maximum diameter {{Moderate-begin}}or 3 dimensions{{Moderate-end}} | |||
:*Determine '''location''': Which lobe if applicable, and if it is peripheral, central or hilar. | |||
:*'''Margin''' length to pleura and hilum/surgical margin. | |||
:*Any '''involvement''' of major bronchi or blood vessels. | |||
*Describe any '''lymph nodes''', including location, range of sizes and appearance of cut surface. | *Describe any '''lymph nodes''', including location, range of sizes and appearance of cut surface. | ||
==Microscopic evaluation== | ==Microscopic evaluation== | ||
Look mainly for '''carcinoma'''. {{further|Lung tumor | Look mainly for '''carcinoma'''. {{further|Lung tumor}} | ||
===Microscopy report=== | ===Microscopy report=== | ||
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:Histologic type | :Histologic type | ||
:Margins | :Margins | ||
{{Reporting}} | |||
{{Bottom}} | {{Bottom}} | ||