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Cell Lysis Due to Ultrasound Gel in Fine Needle Aspirates: An Important New Artefact in Cytology.

A. J. Molyneux, S. B. Coghill. Cytopathology 1994; 5:41–45

Summary

This paper described artifactual changes that occurred in cytologic preparations contaminated with ultrasound gel. The authors described a clinical case that used fine-needle aspiration cytologic examination of a breast carcinoma and initially yielded results unsuitable for diagnosis because of cell and nuclear lysis from ultrasound gel contamination. In a small clinical follow-up study, the effect of ultrasound gel on fine-needle aspirates was confirmed with the use of 6 fresh lymph node and breast specimens intentionally contaminated with ultrasound gel. The study also documented the artifactual changes that occurred with time of exposure to ultrasound gel. Ultrasound gel from 3 different manufacturers caused similar effects.

Critique

The methods used in this study were appropriate for, and representative of, small clinical studies involving observational cytopathology.

Results and Conclusions

A cytopathologic artifact was described from a clinical observational study in which a fine-needle aspirate of a breast carcinoma was examined cytologically. The initial observation of the artifact followed contamination of the aspirate by ultrasound gel that was used in the diagnostic procedure to image and localize the lesion. The aspirate was processed by routine staining methods and evaluated with a light microscope. The artifactual changes that occurred in the aspirate were described. In the small clinical study, aspirate samples from 6 fresh lymph node and breast specimens were intentionally contaminated with ultrasound gel. The artifactual changes that occurred in the aspirates over time were described. The changes proved reproducible ex vivo. Those changes varied depending on the conditions and degree of contamination, and ranged from cell swelling to leakage of nuclear chromatin and cell lysis.

Ultrasound gel from 3 different manufacturers caused similar effects. It was concluded that excessive contamination of the sample with ultrasound gel might lead to lysis of cells, whereas lesser contamination might cause subtler cytoarchitectural changes that could be misinterpreted. Hence, the artifactual changes described in this paper could be potentially serious problems of which the cytopathologist should be aware, because they could result in the misdiagnosis of fine-needle aspiration cytologic findings.

Clinical Relevance

This artifact was discussed in the context of other major sources of cytologic artifacts. Clinical cytopathologists and radiologists should be aware of the potential for detrimental effects of ultrasound gel on cytologic specimens.

Footnotes

The American Institute of Ultrasound in Medicine (AIUM) Bioeffects Committee provides information to the AIUM membership on issues pertaining to the biological effects of ultrasound, especially when these issues relate to the safety of clinical ultrasound. A primary responsibility of the committee is to evaluate research reports on biological effects. These reports were evaluated by committee members and selected experts in the clinical and experimental areas pertinent to the studies. The Bioeffects Committee members included: Diane Dalecki, PhD, chair; James Zachary, DVM, PhD, vice chair; John Abbott, PhD; Jacques Abramowicz, MD; Carol Barnewolt, MD; Phillip Bendick, PhD; Charles Church, PhD; Brian Fowlkes, PhD; Leon Frizzell, PhD; James Greenleaf, PhD; Christopher Merritt, MD; Morton Miller, PhD, MS. Resource members included: Stephen Bly, PhD; Andrew Brayman, PhD; Peter Edmonds, PhD; Kathleen Meschisen, BSChE; Joanne Messick, DVM, PhD; Douglas Miller, PhD; Tariq Siddiqi, MD; Melvin Sikov, PhD; Paul Smolenski; Philip Solter, DVM, PhD; Jinxing Tan, PhD; Marvin Ziskin, MD. Liaison members included: Stanley Barnett, MSc, PhD; Jeanette Burlbaw, BS, RDMS; Richard Melzer, MD, PhD; Mel Stratmeyer, PhD; Terrence Sweeney; Tony Whittingham, PhD. Executive Committee liaison: Christy Holland, PhD. Board of Governors liaisons: Phillip Bendick, PhD; Charles Church, PhD.

Dr Molyneux and Dr Coghill responded to this review in a favorable manner and had no comments on its content.

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