Administrative Office
St. Joseph's Hospital Site, L301-10
50 Charlton Avenue East
HAMILTON, Ontario, CANADA L8N 4A6
PHONE: (905) 521-6141
FAX: (905) 521-6142
http://www.fhs.mcmaster.ca/hrlmp/
DIAGNOSTIC ELECTRON MICROSCOPY
Since 1979, the Electron Microscopy Facility of the Faculty of Health Sciences, McMaster University, has successfully developed diagnostic service at the ultrastructural level. Presently, more than 1300 cases are processed and reported, making the facility one of the largest in North America. The main laboratories of the facility are located at the Health Sciences Centre. A satellite Electron Microscopy laboratory was installed in St. Joseph's Hospital in 1989, to provide ultrastructural services to the centralized Virology laboratory which screens more than 1500 samples a year for viral detection. The satellite is also used to examine surgical specimens, in particular from kidneys and lungs.Most physicians and surgeons are not aware of diagnostic electron microscopy which is an ancillary technique, used in conjunction with other methodologies. Almost all the reports are sent to anatomical pathologists and not to practitioners. Virologists are taking the EM results into consideration in their reports. The total number of surgicals examined in the district of Hamilton is slightly more than 51,000, the numbers sent for ultrastructural examination corresponding to 2.5%. The types of specimens sent can be arbitrarily subdivided into difficult cases, cases in which electron microscopy is the only means to obtain a diagnosis, unusual cases, and confirmation of diagnosis obtained by other techniques. The last group consists of specimens where electron microscopy is used routinely. In this category one finds all muscle biopsies (190 per year), nerve biopsies (60 per year), and approximately 65% of all kidney biopsies (143 per year). In 90% of all nerve biopsies, ultrastructural examination is the only way to provide a diagnosis. In 30% of the muscle biopsies, electron microscopy is necessary to make the diagnosis and, in more than 60%, it gives additional information of therapeutic and prognostic relevance. In all cases of kidney biopsies sent for electron microscopic examination, ultrastructural details have therapeutic and prognostic values.
With the exponential development of immunohistochemistry, it was thought that electron microscopy would become obsolete in the typing of tumours. Interestingly, a decrease in the number of cases was observed with the introduction of routine immunohistochemistry, followed by a sharp increase in cases sent to electron microscopy, thus demonstrating the value of electron microscopy. In the September issue of the Archives of Pathology and Laboratory Medicine, 1994:118 pp.920-926, Frost et al. from the Department of Pathology of the George Washington University in Washington, DC, compared the usefulness of EM and immunohistochemistry in specimens examined by both methods. The results indicated that EM had been helpful in 92% and immunohistochemistry in only 73% of all the cases. This by no means indicates that one of the techniques is superior to the other but emphasizes their complementary use. It also emphasizes that electron microscopy constitutes the quality control par excellence for immunohistochemistry. In the same article, the authors mention that immunohistochemistry could become more expensive than EM when more than 5 or 6 antibodies are used (relevant for the American health care system).
With only a few exceptions, surgical specimens to be examined in the electron microscope should only be sent by an anatomic pathologist and examined in the Electron Microscopy facility by a pathologist specialized in this field.
The Facility at the Health Sciences Centre is providing services for all the research of the faculty and has, therefore, developed expertise in many ultrastructural techniques and modes of utilization of the instruments. It has become evident in the last 10 years that analytical electron microscopy can provide rapid and reliable results for the presence of asbestos, heavy metals, and other substances in tissues or in the composition of calculi. Approximately 50 specimens per year are analyzed by x-ray microanalysis and/or electron diffraction.
It should be emphasized that tissue specimens to be sent for electron microscopical examination should be cut in 1 cubic mm in glutaraldehyde cacodylate buffer fixative. The solution can be obtained from the Electron Microscopy Facility [ph.(905) 525-9140 extn. 22496, FAX (905) 577-0198]. For a nerve biopsy, a different fixative is used. Nerves should not be fixed in any other fixative. This special fixative is also available from the Electron Microscopy facility and is labelled accordingly. For proper orientation of muscle, gut, etc., instruction can be obtained by phoning the above mentioned number and asking for the Chief Technologist, Mr. E. Spitzer. Specimens previously fixed in formalin can also be used. However, only the 1 mm thick external layer of the specimen is adequately preserved and can be used for electron microscopy.
The centralization of electron microscopy for the district of Hamilton has not only provided the community with a high level of expertise in ultrastructural diagnosis, but has also considerably decreased the cost of examining specimens in the electron microscope. In other university centres, diagnostic electron microscopy might be as much as three times more expensive than at McMaster.
We are looking forward to providing further improvements in service, and welcome comments and enquiries. Feel free to phone us at 521-5084, or 521-2100, extension 3710.
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The Hamilton Health Sciences Laboratory Program is a collaborative program of Hamilton Civic, St. Joseph's and Chedoke-McMaster Hospitals, which operate Community Laboratory Services as a service to Hamilton Physicians and their patients.
For further information concerning the Laboratory Program call Mr. A.J. Bailey at 572-7575 and for Community Laboratory Services telephone Mrs. K. Williams at 521-6052.
COMMUNITY LABORATORY SERVICES
Collection Centres
Ancaster Centre
226 Wilson Street E.
Ancaster, Ontario
Tel: (905) 648-4080 / Charlton Centre
25 Charlton Ave. E.
Hamilton, Ontario
Tel: (905) 521-6052 / Dundas Centre
16 Cross St.
Dundas, Ont.
Tel: (905) 627-3814 or
(905) 627-7190 / Fennell Centre
836 Fennell Street E
Hamilton, Ontario
Tel: (905) 383-0505 or
(905) 383-9953
George St. Centre
196 George St.
Hamilton, Ontario
Tel: (905) 525-1562 / Carlisle Centre
1493 Centre Rd.
Carlisle, Ontario
Tel: (905) 689-0818 / Concession Centre
688 Concession St.
Hamilton, Ontario
Tel: (905) 383-2021 / East Hamilton Centre
1463 Main St. East
Hamilton, Ontario
Tel: (905) 549-5004
First Place Centre
350 King St. E., Ste. 103
Hamilton, Ontario / North Hamilton Centre
554 John St. North
Hamilton, Ontario
Tel: (905) 522-4197 / Stoney Creek Centre
2757 King Street E.
Hamilton, Ontario
Tel: (905) 573-4824 / For Housecalls throughout the region, telephone Mrs. K. Williams at (905) 521-6052
For Laboratory Reference Centre Services phone Mrs. B. Baltzer at (905) 521-6065 or fax requests for information to (905) 528-1464