Tissue procurement, sampling, and preparation

Abstract

The approach to the morphological diagnosis of lung disease varies with the type of tissue sample submitted and the associated clinical setting. Tissue samples can be roughly grouped into three major categories: (1) small biopsy specimens; (2) surgical lung biopsy specimens; and (3) large specimens including those obtained by lobectomy, pneumonectomy, or autopsy. The clinical situation usually dictates the manner of tissue procurement. For example, a central endobronchial lesion is approached via endoscopic biopsy under direct visualization, whereas a peripheral or perihilar mass is better accessed by a computed tomography (CT)-guided transthoracic or an endoscopic transbronchial needle biopsy, respectively. Transbronchial forceps lung biopsy is often the initial procedure in stable immunocompetent patients with interstitial lung disease, but an open lung biopsy or a biopsy obtained by video-assisted thoracoscopc surgery (VATS) may be the preferred diagnostic modality in immunosuppressed patients with rapidly evolving pulmonary infiltrates. Regardless of the means of tissue procurement, a review of the clinical and radiological data by the pathologist is essential for appropriate tissue handling and interpretation. © 2008 Springer New York.