Measurement of emphysema in autopsy lungs, with emphasis on interlobar differences

This study clarifies interlobar differences in the severity of emphysema and examines the feasibility of assessing emphysema in a whole lung using either the upper or lower lobes. Midsagittal, paper-mounted whole-lung sections from 79 consecutive autopsies were used. The whole-lung sections were scored by comparing them with the panel of standard pictures from Grades 0 to 100, after which the upper or lower lobes were scored in the same way but with the other lobe covered. Scores made on lobes and whole lungs correlated significantly, but while projections to whole-lung scores were quite accurate from the upper lobe, the projections from the lower lobe were less precise. This was particularly true in patients with mild emphysema. Individual lobes of the same lung sections were assessed by the Ryder grid method. This analysis showed that emphysema was more severe in the upper lobe of the 79 consecutive cases. The panel grading method showed more severe emphysema in the upper lobe than in the lower lobe to a panel score of 40; after this, 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. Grading emphysema from one lobe, particularly the lower lobe, is not appropriate if precise clinicopathologic correlations are required.