Name of the Procedure:

Electron microscopy, diagnostic
Other names: Transmission Electron Microscopy (TEM) and Scanning Electron Microscopy (SEM)

Summary

Electron microscopy is a diagnostic imaging technique that uses a beam of electrons to create a detailed image of tissues, cells, and other biological structures at a very high resolution. This procedure allows healthcare providers to examine tiny structures and detect abnormalities that cannot be seen with traditional light microscopy.

Purpose

Electron microscopy is used to investigate the finer details of cell and tissue structures. It helps diagnose various medical conditions, including specific types of kidney diseases, cancers, muscle disorders, and infectious diseases. The goal is to provide a detailed and precise diagnosis that can guide targeted treatment plans.

Indications

• Unexplained renal diseases
• Muscle disorders like myopathies
• Certain cancers requiring detailed tissue analysis
• Infectious diseases with unclear causative organisms
• Neurological disorders needing precise tissue examination

Preparation

• No special preparation such as fasting or medication adjustments is typically required.
• Patients may need to provide a tissue or biopsy sample.
• Diagnostic tests or assessments to evaluate the suitability of the sample might be conducted.

Procedure Description

1. A small tissue sample is collected (usually via biopsy).
2. The sample is fixed using chemicals to preserve its structure.
3. It is then dehydrated and embedded in a resin block.
4. Very thin slices of the sample are cut using an ultramicrotome.
5. These slices are placed on a grid and stained with heavy metals to provide contrast.
6. The sample is then placed in the electron microscope.
7. A beam of electrons is passed through (TEM) or scanned over (SEM) the sample.
8. The interaction of electrons with the sample creates a high-resolution image, which is captured and analyzed.

Duration

The entire process, including sample preparation and imaging, can take several hours to days depending on the complexity and the urgency.

Setting

Typically performed in specialized laboratories within hospitals, research institutions, or diagnostic centers.

Personnel

• Pathologists or laboratory technicians specialized in electron microscopy
• Support staff assisting with sample preparation and processing

Risks and Complications

• Minimal risks associated with the initial biopsy sample collection
• Rare possibility of sample damage during preparation, leading to a need for a repeat sample
• No direct risks or complications associated with the imaging process, as it is non-invasive

Benefits

• Highly detailed images provide superior diagnostic insights compared to traditional methods.
• Early and accurate diagnosis of various diseases.
• Better-informed treatment due to precise structural analysis.

Recovery

• Minimal to no recovery needed post-biopsy; routine care for biopsy site.
• Follow-up appointments may be scheduled to discuss results and next steps.

Alternatives

• Light microscopy: Less detailed but sufficient for some conditions.
• Imaging techniques like MRI or CT scans: Non-invasive but less detailed for cellular-level diagnosis.
• Pros of electron microscopy include unparalleled resolution and diagnostic accuracy. Cons can be time-consuming and require specialized equipment.

Patient Experience

• During the biopsy, patients may experience slight discomfort or pain, managed with local anesthesia.
• During the electron microscopy procedure itself, the patient is not present; it is the sample that undergoes analysis.
• Post-procedure, pain management for the biopsy site may involve over-the-counter pain relievers and following care instructions.