Difference between revisions of "Lung wedge resection and lobectomy"

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|author2=
 
|author2=
 
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{{Comprehensiveness}}
 
==Grossing==
 
==Grossing==
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===Intraoperative consultation===
 
 
[[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.]]
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Unless otherwise requested, [[ink]] the '''surgical margin''' closest to the tumor and perform [[frozen sectioning]] of the tissue enface, for radicality. 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.
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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>
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===Non-intraoperative consultation===
 
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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.
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*Serially '''section''' the specimen. Describe the cut surface, including color and consistency, and any focal lesions. For tumors, see '''[[Lung tumor]]'''
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*'''Palpate''' for any tumors.
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*[[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.
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:*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.
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*{{Comprehensive-begin}}Sample the entire surgical margin for standard processing.{{Comprehensive-end}}
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*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.
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*Turn the specimen to the side with least cuts so far, and '''serially section''' it.
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*For any found '''[[lung tumor]]''':
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:*Measure '''tumor size''' as a maximum diameter {{Moderate-begin}}or 3 dimensions{{Moderate-end}}
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:*Determine '''location''': Which lobe if applicable, and if it is peripheral, central or hilar.
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:*'''Margin''' length to pleura and hilum/surgical margin.
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:*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==
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Look mainly for '''carcinoma'''. {{further|Lung tumor|linebreak=no}}
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Look mainly for '''carcinoma'''. {{further|Lung tumor}}
  
 
===Microscopy report===
 
===Microscopy report===
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:Histologic type
 
:Histologic type
 
:Margins
 
:Margins
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{{Reporting}}
 
{{Bottom}}
 
{{Bottom}}

Revision as of 10:51, 19 March 2021

Author: Mikael Häggström [note 1]

Comprehensiveness

On this resource, the following formatting is used for comprehensiveness:

  • Minimal depth
  • (Moderate depth)
  • ((Comprehensive))

Grossing

Surgical margin sampling of a lobectomy for intraoperative consultation.

Perform the following:[1]

  • Measure the specimen in 3 dimensions.
  • 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.
  • ((Sample the entire surgical margin for standard processing.))
  • 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 (or 3 dimensions)
  • 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.

Microscopic evaluation

Look mainly for carcinoma. Further information: Lung tumor

Microscopy report

Lung synoptic reports contain information (number and station) on all lymph nodes received per accession. For example, if Parts A-D are mediastinal nodes (8 in total) and Part E is a lobectomy containing 2 additional peribronchial nodes, the synoptic report for Part E should document all 10 nodes, for example:

A. Lymph node, station 1:
Negative for carcinoma. (0/1, 2 etc)

B. Lymph node, station 2:
Negative for carcinoma. (0/1, 2 etc)

C. Lobectomy, RLL: Adenocarcinoma

Size:
Histologic type
Margins

  See also: General notes on reporting


Notes

  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. ↑ Partially using the following procedure:. Pulmonary pathology grossing guidelines. Retrieved on 2021-03-17.

Image sources


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