Electron microscopy in the diagnosis of percutaneous fine needle aspiration specimens

Our plain-English summary of Electron microscopy in the diagnosis of percutaneous fine needle aspiration specimens, by E.J. Wills, S. Carr, J. Philips (Ultrastructural Pathology, 1987).

The study

• Authors: E.J. Wills, S. Carr, J. Philips
• Journal: Ultrastructural Pathology
• Published: 1987;11(4):361-87
• Cited by: 32 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Five years experience in the application of electron microscopy to fine needle aspiration biopsy specimens is reviewed. In an initial evaluation, 200 consecutive unselected specimens were examined; 89 proved diagnostic and, in a third of these, electron microscopy gave additional information that was often essential to diagnosis. Negative specimens resulted almost entirely from failure to obtain an adequate amount of material. Results were improved by the adoption of a preparation technique involving concentration of the cells in bovine serum albumin and by the inspection of a rapidly stained smear at the time of the aspiration procedure, with a further needle pass for electron microscopy being performed if necessary. Despite the small size of specimens, adequate examination was usually possible and electron microscopy has proved of value in the diagnosis of tumor samples acquired by fine needle aspiration in the same way as has been established with the larger sized specimens obtained by conventional biopsy and surgical resection.

In plain English

This article reviewed five years of the authors' experience at Royal Prince Alfred Hospital, Australia, using electron microscopy on fine needle aspiration samples (cells drawn from lumps through a thin needle). It was not a study of asbestos. Of an initial 200 consecutive unselected specimens, mostly from the lung, 89 proved diagnostic. In 30 of these, electron microscopy added information beyond light microscopy. The 111 nondiagnostic specimens resulted almost entirely from failure to obtain enough material. More than 600 samples were examined in all, and the article described illustrative cases. One was a 68-year-old man with left pleural and mediastinal disease who smoked 20 to 30 cigarettes a day and reported past occupational exposure to asbestos. His needle sample was consistent with mesothelioma, and electron microscopy substantiated that diagnosis. The authors concluded that electron microscopy yielded information important to treatment in up to a third of aspirates. They noted that the large nondiagnostic share reflected unselected specimens and the use of only the material left over after cytology.

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: Single-center review of five years of experience (case series), with an initial evaluation of consecutive unselected specimens followed by selective use, and illustrative case histories
• Who was studied: Initially 200 consecutive percutaneous fine needle aspiration specimens from deep sites (119 from lung, 33 from bone, the rest from other sites); more than 600 samples examined to date; Royal Prince Alfred Hospital, Camperdown NSW, Australia; work begun towards the end of 1980
• Exposure: Not an asbestos exposure study. The exposure studied was the use of electron microscopy on needle aspirates. One illustrative mesothelioma patient had a history of past occupational exposure to asbestos; no fiber type, job or dose was given.
• Main results:
  • Of the initial 200 unselected specimens, 89 proved diagnostic; in a third of these, electron microscopy gave additional information
  • In 30 of the 89 diagnostic specimens, electron microscopy gave additional information (Table 2); 111 specimens were nondiagnostic
  • Nondiagnostic specimens resulted almost entirely from failure to obtain enough material
  • At the time of writing, about one third of specimens received contained no tumor or were otherwise inadequate
  • Switching from the agar method to the bovine serum albumin concentration method reduced the number of samples reported as blood only
  • Mesothelioma case (68-year-old man with extensive anterior mediastinal and left pleural disease and past occupational asbestos exposure): a pleural core biopsy suggested mesothelioma but could not exclude squamous carcinoma; needle aspiration cytology was consistent with mesothelioma and electron microscopy substantiated the diagnosis
• The authors' conclusion: The authors concluded that electron microscopy yields additional information important to patient therapy in up to a third of aspirates examined, and that it is of value in diagnosing tumor samples obtained by fine needle aspiration, as it is with larger biopsy and surgical specimens
• Limitations the authors state:
  • The nondiagnostic proportion of the first 200 specimens was large; the authors attributed this to the specimens being unselected
  • Only the material remaining after cytology needs had been met was used for electron microscopy in the initial series
  • Sampling error is a greater concern with aspirates than with conventional specimens
  • The bovine serum albumin method added roughly another working day of preparation time
  • Case series from a single center tend to reflect that institution's specialist interests

Topics

Medical terms in this study, explained in our Lexicon: Biopsy, Surgical Resection.

Related studies

• Diagnostic electron microscopy using fine needle aspiration biopsies — B. Mackay, T. Fanning, et al. (1987)
• Percutaneous image-guided fine-needle aspiration of peritoneal lesions — L.J. Layfield, E.V. Gopez (2003)
• Diagnosis of malignant mesothelioma by fine needle aspiration of a cervical lymph node. A case report — N.A. Ansari, N.W. Derias (2000)
• Transbronchial needle aspiration for histology specimens — A.C. Mehta, M.S. Kavuru, et al. (1989)
• Pulmonary needle aspiration biopsy in the diagnosis of Pancoast tumors — W.J. Walls, J.R. Thornbury, et al. (1974)
• Advantages of thoracic ultrasound-guided fine-needle aspiration biopsy in lung cancer and mesothelioma — M. Sperandeo, L. Dimitri, et al. (2014)

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