Mukherjee T M, Smith K, Swift J G
Scan Electron Microsc. 1983(Pt 3):1317-27.
A review of the literature on the application of scanning electron microscopy (SEM) and transmission electron microscopy (TEM) to cytodiagnosis of neoplastic cells in effusion fluid reveals a lack of consensus as to which of the techniques is most beneficial to a cytologist for a satisfactory diagnosis. The purpose of this study is therefore to critically evaluate the relative merits of SEM, TEM and freeze-fracture (FF) techniques in enhancing the diagnostic "sensitivity" of ultrastructural cytology. Two cases of adenocarcinoma, one case of mesothelioma and one case of small cell undifferentiated carcinoma of the lung were studied in detail by SEM, TEM and FF techniques. A comparative analysis of the results demonstrates that SEM is a rapid and useful technique where the microvilli on the tumour cell surface is the most prominent feature especially in adenocarcinomas. The major handicap of SEM becomes evident in cases where the extreme variability of the surface morphology amongst tumour cells makes it difficult to establish a diagnosis with confidence. TEM along with light microscopy (LM) of toluidine blue sections gives us the most comprehensive method for cyto-diagnosis and is particularly useful in cases where LM cytology alone is inconclusive. It has the added advantage of revealing diagnostically significant nuclear and cytoplasmic features which are helpful in differentiating a benign from a malignant cell and in some instances the probable site of the primary neoplasm. FF technique, though not conducive to a routine diagnostic situation, is of benefit in demonstrating the organization of junctional complexes. From preliminary studies it appears that the tight junctions in adenocarcinoma are different from those seen in small cell carcinoma. In mesothelioma, gap junctions are invariably present, but they are not seen prominently in adenocarcinoma or small cell carcinoma. Thus in poorly differentiated tumours where LM and TEM are inconclusive, FF may prove useful. It is concluded that such coordinated studies in the future have the potential to better our understanding of the nature and behaviour of tumour cells in effusion fluid.
对有关扫描电子显微镜（SEM）和透射电子显微镜（TEM）应用于积液中肿瘤细胞的细胞诊断的文献综述显示，对于这两种技术中哪一种对细胞学家进行满意诊断最有益，目前尚无共识。因此，本研究的目的是严格评估SEM、TEM和冷冻断裂（FF）技术在提高超微结构细胞学诊断“敏感性”方面的相对优点。通过SEM、TEM和FF技术对2例腺癌、1例间皮瘤和1例肺小细胞未分化癌进行了详细研究。结果的比较分析表明，SEM是一种快速且有用的技术，尤其是在腺癌中，肿瘤细胞表面的微绒毛是最突出的特征。当肿瘤细胞之间表面形态的极端变异性使得难以自信地做出诊断时，SEM的主要缺陷就变得明显了。TEM与甲苯胺蓝切片的光学显微镜（LM）相结合，为细胞诊断提供了最全面的方法，在仅LM细胞学诊断不明确的情况下特别有用。它还有一个额外的优点，即能够揭示具有诊断意义的核和细胞质特征，这有助于区分良性细胞和恶性细胞，在某些情况下还能确定原发性肿瘤的可能部位。FF技术虽然不利于常规诊断情况，但在展示连接复合体的组织方面是有益的。初步研究表明，腺癌中的紧密连接与小细胞癌中的不同。在间皮瘤中，间隙连接总是存在，但在腺癌或小细胞癌中不明显。因此，在低分化肿瘤中，当LM和TEM诊断不明确时，FF可能会证明是有用的。结论是，未来这样的协同研究有可能更好地增进我们对积液中肿瘤细胞的性质和行为的理解。
