Artifact associated with the use of strong iodine solution (Lugol's) in cone biopsies

The preoperative application of strong iodine solution (USP), commonly referred to as Lugol's solution, induces a histologic artifact in epithelial cells of cone biopsy material, most pronounced in dysplastic cells. Cellular shrinkage, cytoplasmic eosinophilia and vacuolization, development of visible intercellular space, and nuclear pyknosis with loss of chromatin detail are the major findings. Since the use of strong iodine solution (USP) is a common practice for delineating the ectocervical extent of disease prior to cone biopsy, the pathologist should recognize the artifact since its presence can make histologic interpretation difficult. Because the artifact may lead to interpretation error, alternatives to strong iodine solution (USP) should be considered.