Diagnostic electron microscopy using fine needle aspiration biopsies

Our plain-English summary of Diagnostic electron microscopy using fine needle aspiration biopsies, by B. Mackay, T. Fanning, J.M. Bruner, et al (Ultrastructural Pathology, 1987).

The study

• Authors: B. Mackay, T. Fanning, J.M. Bruner, M.C. Steglich
• Journal: Ultrastructural Pathology
• Published: 1987;11(5-6):659-72
• Type of article: Case report
• Cited by: 25 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Electron microscopy can be a valuable aid to light microscopy in the interpretation of fine needle aspiration biopsies of tumors, but considerable care in procuring and processing the specimen is necessary to recover the tumor cells and avoid altering their fine structure. Fixation followed by filtration through a cloth screen is recommended. Experience with this technique is briefly reviewed.

In plain English

This article, from the University of Texas M.D. Anderson Hospital, described how tumor cells taken by fine needle aspiration biopsy can be prepared for electron microscopy, and briefly reviewed the authors' experience. It is not a study of asbestos exposure and does not mention asbestos. In experiments on cells aspirated from rat liver, holding cells in physiological solutions, or removing red blood cells with hemolysing agents, changed the cells' fine structure without exception, often severely. Separation in a Ficoll medium preserved cells adequately but made it hard to recover small numbers of cells. The most reproducible approach was to fix the cells first in buffered glutaraldehyde and then pass them through a fine nylon cloth screen. The authors illustrated the method with seven single-patient cases. One was a 51-year-old man with a pleural-based mass, in whom comparing the cells' cytologic and ultrastructural features led to a diagnosis of mesothelioma. The authors recommended fixation followed by filtration, but said the method is not consistently effective.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Technical methods article describing the authors' experience, with laboratory experiments on rat liver cells and seven illustrative case reports
• Who was studied: Cells aspirated from rat liver for method experiments, plus seven patients whose tumors were aspirated (ages 5 weeks to 70 years), at the University of Texas M.D. Anderson Hospital, Houston
• Main results:
  • In rat liver cells, holding in physiological solutions (15 minutes to 1 hour) and hemolysis for 10 or 30 seconds with distilled water, 2 M urea, or 0.8 M NaCl all altered the cells' fine structure.
  • Gradient centrifugation in a Ficoll medium preserved cells adequately but made recovery of small numbers of cells difficult.
  • Fixing cells first and then passing them through a fine filter (the technique of Akhtar et al.) was the most reproducible way to obtain enough acceptably preserved cells.
  • Case 3: in a 51-year-old man with a pleural-based mass, correlating the cytologic features of the malignant cells with their ultrastructure led to a diagnosis of mesothelioma. Electron microscopy showed many slender curving microvilli.
  • The authors stated that the microvilli of a relatively well differentiated mesothelioma are distinctive and can be seen in aspiration biopsy specimens. They cautioned against confusing reactive with neoplastic mesothelial cells.
• The authors' conclusion: The authors concluded that fixation with agitation followed by filtration through a cloth screen offered, in their hands, the best and most reproducible method for recovering tumor cells for ultrastructural study.
• Limitations the authors state:
  • The method is not consistently effective; the authors still obtained some low yields and many damaged cells.
  • The small number of cells and their tendency to separate make interpretation more difficult than with solid tumor specimens.
  • When only a few cells are obtained, it may not be possible to rule out that they are reactive rather than tumor cells.

Related studies

• Electron microscopy in the diagnosis of percutaneous fine needle aspiration specimens — E.J. Wills, S. Carr, et al. (1987)
• Fine-needle aspiration biopsy of axillary lymph nodes — S. Jaffer, M. Zakowski (2002)
• Well-differentiated papillary mesothelioma of the peritoneum: a diagnostic dilemma on fine-needle aspiration cytology — J.G. Nasit, G. Dhruva (2014)
• Small cell mesothelioma: A rare entity and diagnostic pitfall mimicking small cell lung carcinoma on fine-needle aspiration — Y. Zhang, A. Afify, et al. (2016)
• Fine-needle aspiration cytology of localized fibrous tumor of pleura — D. Dusenbery, M.M. Grimes, et al. (1992)
• The potential value of comparative genomic hybridization analysis in effusion-and fine needle aspiration cytology — H. Nagel, H.J. Schulten, et al. (2002)

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