MEASUREMENT OF EMPHYSEMA IN AUTOPSY LUNGS, WITH EMPHASIS ON INTERLOBAR DIFFERENCES

This study clarifies interlobar differences in the severity of emphyse ma and examines the feasibility of assessing emphysema in a whole lung using either the upper or lower lobes. Midsagittal, paper-mounted who le-lung sections from 79 consecutive autopsies were used. The whole-lu ng sections were scored by comparing them with the panel of standard p ictures from Grades 0 to 100, after which the upper or lower lobes wer e scored in the same way but with the other lobe covered. Scores made on lobes and whole lungs correlated significantly, but while projectio ns to whole-lung scores were quite accurate from the upper robe, the p rojections from the lower robe were less precise. This was particularl y true in patients with mild emphysema. Individual lobes of the same l ung sections were assessed by the Ryder grid method. This analysis sho wed that emphysema was more severe in the upper robe of the 79 consecu tive cases. The panel grading method showed more severe emphysema in t he upper lobe than in the lower lobe to a panel score of 40; after thi s, the severity of emphysema in the two lobes was similar. Scores made from the Ryder grid were very similar to those made from the panel. G rading emphysema from one lobe, particularly the lower lobe, is not ap propriate if precise clinicopathologic correlations are required.