Dardick I, Yazdi H M, Brosko C, Rippstein P, Hickey N M
Department of Pathology, Toronto General Hospital, Ontario, Canada.
Ultrastruct Pathol. 1991 Mar-Apr;15(2):105-29. doi: 10.3109/01913129109016230.
Because fine-needle aspiration biopsy (FNAB) is being increasingly used as a primary diagnostic tool, it is essential to obtain the maximum information from the aspirate. Electron microscopy is an adjunctive procedure that is readily applied to FNAB specimens. The value of electron microscopy to the cytopathologist was assessed by comparing the initial, tentative, or interim diagnosis based on light microscopic features with the diagnosis resulting from the ultrastructural characteristics of needle rinse material. Over a 3-year period, 279 FNAB specimens obtained under radiologic control were examined ultrastructurally; of these, 57 (20.4%) were considered inadequate specimens for diagnostic purposes. The remaining 222 FNAB specimens were segregated into four groups: 17 cases (7.7%) in which electron microscopy played a major role because the final diagnosis was unsuspected from light microscopy; 43 cases (19.4%) in which electron microscopy selected a specific diagnosis from a set of differential diagnoses or provided additional information that was clinically relevant; 45 cases (20.3%) in which additional diagnostic information was obtained by electron microscopy but was not clinically relevant; and 117 cases (52.6%) in which electron microscopy was not helpful because the light and electron microscopic diagnoses were the same. In this comparative study, electron microscopy provided a major contribution to the final cytologic diagnosis in 27.1% of the cases (groups 1 and 2). Descriptive examples illustrate how the architectural and cytologic features revealed by electron microscopy assist in establishing the final diagnosis. Examination of needle rinse specimens, particularly aspirates from lung and liver, indicates that most FNABs provide mini-surgical biopsy specimens that are well suited to ultrastructural examination.
由于细针穿刺活检（FNAB）越来越多地被用作主要诊断工具，从穿刺物中获取最大量信息至关重要。电子显微镜检查是一种易于应用于FNAB标本的辅助检查方法。通过将基于光学显微镜特征的初步、暂定或临时诊断与针冲洗材料超微结构特征得出的诊断进行比较，评估了电子显微镜检查对细胞病理学家的价值。在3年期间，对279例在放射学控制下获取的FNAB标本进行了超微结构检查；其中，57例（20.4%）被认为是诊断用途不充分的标本。其余222例FNAB标本分为四组：17例（7.7%），电子显微镜检查起主要作用，因为最终诊断在光学显微镜下未被怀疑；43例（19.4%），电子显微镜检查从一组鉴别诊断中选择了特定诊断或提供了临床相关的额外信息；45例（20.3%），通过电子显微镜检查获得了额外诊断信息，但与临床无关；117例（52.6%），电子显微镜检查无帮助，因为光学和电子显微镜诊断相同。在这项比较研究中，电子显微镜检查在27.1%的病例（第1组和第2组）中对最终细胞学诊断有重大贡献。描述性示例说明了电子显微镜检查揭示的结构和细胞特征如何有助于确立最终诊断。对针冲洗标本的检查，特别是来自肺和肝的穿刺物，表明大多数FNAB提供了非常适合超微结构检查的微型手术活检标本。
