Lingular lung biopsy: is it representative?

Abstract

Some investigators feel that the lingula should be avoided as a site of open lung biopsy because of the assumed prevalence of nonspecific changes. We sought to judge the validity of the lingular biopsy by examining specimens of the lingula and left lower and right upper lobes from 50 consecutive unselected autopsies. Sections were stained with hematoxylin-eosin and Masson's trichrome and were examined for the extent of fibrosis, pulmonary vascular changes, and acute and chronic inflammation. Using both a morphometric and a semiquantitative grading system (r = 0.80), we noted that both fibrosis and pulmonary vasculopathy were more evident in the lingula than in either of the 2 other lung segments (p less than 0.05 ANOVA, Newman-Keul test). There was no difference between the lingula and other segments for either acute or chronic inflammation (p greater than 0.10), and there was no difference in any of the morphologic parameters between the right upper and left lower lobes (p greater than 0.10). We conclude that the lingula shows nonspecific changes and thus may not be a valid biopsy site.