PATHOLOGICAL FINDINGS IN LUNG-VOLUME REDUCTION SURGERY

Purpose: Lung volume reduction surgery (LVRS) has re-emerged as an alt ernative in the management of patients with chronic, debilitating, emp hysematous lung disease. This has permitted the formal evaluation of p athologic pulmonary changes present in these patients. This study seek s to describe systematically the pathologic findings present in patien ts undergoing LVRS. Methods: Tissue sections stained with hematoxylin- eosin, as well as special stains, were retrospectively reviewed from t he specimens of 65 nonconsecutive LVRS patients (male patients, 66%; f emale patients, 31%; mean age, 63.2 +/- 6.76 yr). All operations were conducted via an open technique (bilateral, 83%; unilateral, 17%). Res ults: Histologic emphysema grade was mild in 9%, moderate in 72%, and severe in 19% of patients. Microscopic bullae were noted in 75% of spe cimens. Three patients, each with radiographic evidence of a lesion pr eoperatively, had small (1.1 to 2.8 cm) adenocarcinomas. Granulomatous bronchiolitis and pneumonitis were noted in one patient who postopera tively developed progressive respiratory compromise. An old, inactive aspergilloma was found in the specimen of another patient. Additional findings of potential clinical significance included bronchiolitis (54 ), bronchiolectasis (6), and bronchoalveolar metaplasia (1). Incidenta l findings included interstitial fibrosis and scar (55), interstitial inflammation (20), calcification (20), and ossification (11), bone mar row emboli (4), chemodectoma (2), and carcinoid tumorlets (1). Conclus ion: This systematic analysis of the resected specimens from patients undergoing LVRS describes a wide range of pathologic findings, includi ng those clinically relevant, as well as incidental. As the applicatio n of LVRS continues to expand, the likelihood of discovering clinicall y significant pathologic lesions (eg, carcinoma) will undoubtedly incr ease.