The Continuing Value of Electron Microscopy in Surgical Pathology

Abstract

For decades, transmission electron microscopy has played a valuable diagnostic role in surgical pathology. The continuing importance of electron microscopy, however, can be debated, given the major advances that have occurred in immunohistochemistry and other techniques. Electron microscopy retains excellent educational potential and broad research applicability, and it continues to be a necessity for the evaluation of a small subset of surgical pathology cases, such as renal biopsies and cilia specimens. The real controversy, then, centers on the contribution of electron microscopy in the evaluation of neoplasms. The opinion of many experts indicates that electron microscopy is still vital in the diagnostic assessment of some neoplasms, and that both electron microscopy and immunohistochemistry are more powerful when viewed as complementary rather than competitive techniques. For electron microscopy to be used to its potential, however, electron microscopists must function effectively as consultants. When optimally applied, electron microscopy remains an essential diagnostic tool.

Clinical Electron Microscopy

“…SARS, bird flue, anthrax-attack) [3]. Based on the example of our centralised EM unit in a clinical context, we confirm the continuing value of EM diagnosis in surgical pathology of tumours [5] and numerous non-neoplastic indications like renal, muscle, nervous system, skin, ciliar defects, storage diseases, toxic lesions, male infertility (centriolopathy), and opportunistic infections, as already documented by others in detail [6,7].…”

Contribution of Electron Microscopy to the Final Diagnosis of Renal Biopsies in Egyptian Patients

“…Its use in other areas of diagnosis such as tumours has declined considerably; in addition, in view of the unavoidable financial pressure for the reduction of costs due to investigations and diagnostic routines, the selection of cases for EM has been quite rigorous [2].…”

Que reste t-il de la microscopie électronique pour le diagnostic anatomopathologique en 2010 ?

“…Les nouvelles orientations économiques du secteur public ne favorisent guère le maintien d'un équipement de ce type dans le cadre de l'offre de soins aux patients, ainsi que celui d'un personnel technique hautement qualifié uniquement dédié à cette activité. Toutefois, il est incontournable que les pathologistes puissent avoir la possibilité de faire des analyses ultrastructurales dans des cas bien ciblés et sur des indications bien posées [52]. En effet, la confrontation des images observées en ME, avec celles observées en microscopie optique, les résultats des analyses immuno-histochimiques et/ou moléculaires et les données cliniques, est parfois d'un apport diagnostique important et doit être du domaine de l'expertise médicale [53].…”