Scope of scanning electron microscopy, transmission electron microscopy and freeze fracture technique in diagnostic cytology of effusions.

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.