Journal of Pulmonology and Respiratory Diseases
Open Access

Pulmonary emphysema; Pathologists; Lung disease; Microscopically study; Pathological diagnosis

Introduction

In a random sample of patients who died at the Royal Victoria Hospital in Montreal and were older than 20 years old, the incidence of destructive pulmonary emphysema was found. The methodology used in this study was largely the same as that outlined in Thurlbeck's 1963 analysis of the prevalence of emphysema at Massachusetts General Hospital in Boston. In a nutshell, lungs were examined from necropsies carried out at random intervals throughout the week. Each of the 150 necropsies performed during these times yielded at least one lung that had been inflated with intrabronchial formalin to appear full inflation. When both lungs were available, as in 61 cases, the other lung was stretched using a variety of methods. Heard's method of barium impregnation was used to slice the lungs and analyze them under a dissecting microscope [1]. Emphysema was rated based on a variation of the grading proposed by a Ciba Guest Symposium in 1959. The right lung was used to identify and grade the emphysema when both lungs were accessible. We'll refer to this group of 150 instances as the "inflated lung group." Additionally, six pathologists who frequently participated in the oversight of necropsies examined 15 uninflected lungs. At the time of the evaluation, they were unaware of the ages, sexual orientations, or clinical histories of the 15 patients. Each pathologist received duplicate sections that were cut from the lung blocks that the resident had taken for histological analysis [2].

Diagnosis

The panel of pathologists classified the diagnosis of acute or compensatory emphysema as acute hyperinflation and excluded it from the group of mild emphysema [3]. One observer noted the discovery of secondary carcinomatosis-induced emphysema. This was disqualified as an illustration of emphysema. In these cases, the opposing lung was distended with formalin to seem fully inflated, and the writer determined the degree of emphysema using the techniques described for the "inflated lung group [4, 5]."

Results

Emphysema was substantially more common (P 0.05) in the group with inflated lungs (41-3%) than in the uninflated group (28-6%). Since the incidence of lesions in female inflated lungs was lower than that in female inflated lungs (25%), this rise was completely attributable to the higher prevalence of lesions observed in male lungs (64% vs to 31-4%). The difference between the two groups of men, however, is statistically significant (PO-OO1) while the latter difference is not (P>005). Emphysema occurs more frequently in males than in women in both groups, but the inflated lung series shows this difference to be more pronounced [6,].

Discussion

The discovery that the prevalence of emphysema was higher in a sample of carefully checked inflated lungs than in a retrospective survey of documented diagnoses in a series of necropsies where only uninflated lungs were available for routine examination is not particularly surprising. This could be explained by a greater interest in finding low-grade emphysema in the inflated lungs. However, taking into account the different sex occurrence simply demonstrates that this is not the cause [7]. The much greater frequency of emphysema reported in men is the sole cause of the increased incidence of emphysema in the expanded lungs. From the fourth to the sixth decade, the incidence in the group with expanded lungs rises quickly before levelling off. On the other hand, as people age, the incidence as seen in the uninflated lungs increases3 quite gradually. Therefore, it is clear that the diagnosis of emphysema that was recorded in the retrospective survey of uninflated lungs did not correspond well to the diagnosis that was documented by meticulous examination of inflated lungs. There is no reason to believe that while the latter group was carefully chosen at random to be typical of the necropsy population, the prevalence of emphysema was different in any manner between the two groups. It should be mentioned that both investigations were conducted on inflated lungs, and both found that the age and sex incidence of emphysema in the random cases studied was comparable to that seen in a necropsy population in Boston, United States. The unavoidable conclusion that must be drawn is that the diagnosis of emphysema in uninflated lungs is unreliable and that conventionally performed retrospective necropsies will not yield any useful knowledge regarding the prevalence of emphysema. However, the diagnosis of emphysema in uninflated lungs is not entirely incorrect. If this were the case, there shouldn't be a variation in incidence between the sexes [8]. However, a significant difference (P 0 05) was found. This disparity can be explained in part by the fact that pathologists were influenced by the clinical data. Emphysema is more frequently diagnosed clinically in males than in women; hence pathologists would more frequently document cases of men than women. Since it is impossible to calculate with confidence the probability that each observer made the correct diagnosis by accident, statistical analysis of these results is exceedingly challenging. However, it is evident that there is significant inter-observer variability in the evaluation of emphysema using uninflated lungs. Furthermore, their evaluation did not agree well with that of the opposing inflated lung. Emphysematous lungs are not infrequently recognized as such, although non-emphysematous lungs are frequently regarded as emphysematous, assuming bilateral symmetry and accurate diagnosis in the contralateral lung. The significant difference in emphysema prevalence between uninflated male and female lungs likely reflects a flawed understanding of the real, stark disparity between the sexes, which is further complicated by the frequent, incorrect identification of non-emphysematous lungs in both sexes. Two patients who were included because they had clinically symptomatic chronic lung disease, of which one died, were also of interest. Both lungs weren't perceived to have emphysema by all observers, and just one person thought that one lung had more severe emphysema than the other [9, 10].

Conclusion

An sufficient random sample of necropsies was used to compare the prevalence of emphysema in inflated, fixed lungs to that observed in a population whose lungs were not inflated postmortem. Although there was a substantial difference in prevalence between the sexes in both groups, the sex and age distributions of emphysema in the uninflated lung group did not closely resemble those of the inflated lung group. Six pathologists evaluated fifteen uninflated lungs and noted whether emphysema was present and how severe it was. These lungs may even be thought to be free of emphysema, even though they have moderately severe and clinically symptomatic emphysema.

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