Ranking the severity of emphysema on whole lung slices. Concordance of upper lobe, lower lobe, and entire lung ranks.

This study describes a modification of a standard method for grading emphysema that was originally described by Thurlbeck for postmortem lungs. The study was based on pneumonectomy specimens that were fixed in inflation and sliced sagittally. The midsagittal slice was impregnated with barium sulphate and examined under water by 2 observers on 2 separate occasions. It was then re-examined on 2 additional occasions with either the upper or the lower lobe covered and the grade assigned using the uncovered lobe. In each case, the grade was assigned by comparing the specimen with the panel of pictures of paper sections of lung provided by Thurlbeck and coworkers. The data showed good agreement between grades assigned on separate observations of the same lobe. They also showed that the order of cases from no emphysema to severe emphysema was changed little when the grade was assigned by observing either the upper or the lower lobe. We conclude that this modification of the previous technique described by Thurlbeck and coworkers provides a simple reliable method of ranking surgical lung specimens as to the severity of emphysema present.