A Protocol for the Handling of Tissue Obtained by Operative Lung Biopsy: Recommendations of the chILD Pathology Co-Operative Group

Abstract

This is the first of a series on pediatric pulmonary disease that will appear as Perspectives in Pediatric Pathology over the coming months. The series will include practical issues, such as this protocol for handling lung biopsies and another on bronchoalveolar lavage in childhood, as well as reviews of advances in various areas in pediatric pulmonary pathology. It has been 11 years since the last Perspectives on pulmonary disease. Much has happened since then in this area, and this collection will highlight some emerging and rapidly advancing areas in pediatric lung disease. These will include a review of molecular mechanisms of lung development, and another of mechanisms of pulmonary vascular development. The surfactant system and its disorders, as well as recent advances in the biology of the pulmonary neuroendocrine system and mechanisms of respiratory viral disease, will be addressed. Articles on pulmonary hypertension, pulmonary neoplasia, and pediatric lung transplantation, with their implications for the pediatric pathologist, are also planned. The contributors to this series are a diverse group with special interests and expertise in these areas. As Dr. William Thurlbeck noted in his foreword to the previous volume, Pulmonary Disease, volume 18 of Perspectives in Pediatric Pathology, pediatric pathology had been largely concerned with phenomenology, rather than with mechanisms, model systems, and experimental investigation. I think he would have been pleased to see the changes that have occurred over the past 10 years in pediatric lung biology and pathology in particular, because these were particularly favored interests of his later years.

Diffuse Lung Disease in Young Children

“…Similar to experience with ILD in adults (2), a proportion of the biopsies were deemed nondiagnostic (12%), largely due to inadequate tissue sampling. To address this problem, a consensus protocol for handling tissue obtained at surgical lung biopsy has recently been published (40).…”

An Official American Thoracic Society Clinical Practice Guideline: Classification, Evaluation, and Management of Childhood Interstitial Lung Disease in Infancy

“…OLB has been the primary surgical approach in young children (120,121,132,133). However, VATS visualizes a greater percentage of the lung and permits the sampling of different lobes with the same incision sites (a consensus statement recommends multiple biopsy sites [134], even though there are limited data to support this approach [58]). Studies that have evaluated pediatric lung biopsy using VATS found less postoperative and long-term morbidity compared with OLB (16,135,136).…”

An Official Research Policy Statement of the American Thoracic Society/European Respiratory Society: Standards for Quantitative Assessment of Lung Structure

“…They are typically greater than 1 cm along each dimension in children (173) and up to 4 cm in adults (168), large enough for subdivision into separate portions for different purposes. Each portion should extend from the pleural base to the deepest part of the biopsy so that it is representative of the whole sample and not only a sub-region.…”