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Diagnostic utility of bilateral bone marrow examination
Significance of morphologic and ancillary technique study in malignancy
Article first published online: 11 MAR 2002
Copyright © 2002 American Cancer Society
Volume 94, Issue 5, pages 1522–1531, 1 March 2002
How to Cite
Wang, J., Weiss, L. M., Chang, K. L., Slovak, M. L., Gaal, K., Forman, S. J. and Arber, D. A. (2002), Diagnostic utility of bilateral bone marrow examination. Cancer, 94: 1522–1531. doi: 10.1002/cncr.10364
- Issue published online: 11 MAR 2002
- Article first published online: 11 MAR 2002
- Manuscript Accepted: 29 OCT 2001
- Manuscript Revised: 24 SEP 2001
- Manuscript Received: 13 AUG 2001
- National Institutes of Health. Grant Numbers: CA-33572, CA-30206
- bone marrow biopsy;
- flow cytometry;
- molecular diagnosis
To retrospectively evaluate the significance of morphologic examination and ancillary studies performed on bilateral bone marrow biopsy specimens, 1864 bone marrow samples were studied.
Bilateral bone marrow biopsy specimens included 883 specimens that were evaluated for involvement by non-Hodgkin lymphoma (NHL); 381 specimens that were evaluated for involvement by carcinoma (CA); 362 specimens that were evaluated for involvement by Hodgkin disease (HD); 94 specimens that were evaluated for involvement by sarcoma (SA); 56 specimens that were evaluated for involvement by multiple myeloma (MM); 53 specimens that were evaluated for involvement by acute and chronic leukemia, myelodysplasia, and/or myeloproliferative disorders (LEUK); and 35 specimens that were evaluated for other reasons.
Of all 1864 specimens, 410 samples (22.0%) were positive for disease, including 77% of MM samples, 58% of LEUK samples, 29.6% of NHL samples, 14% of SA samples, 9.9% of HD samples, and 6.8% of CA samples. A discrepancy between the left and right sides was identified in 48 specimens (11.7% of positive samples). The discrepancy rate was 39% for HD samples, 29% for SA samples, 23% for CA samples, and 9.2% for NHL samples. No morphologic discrepancies between bilateral samples were found in MM samples or LEUK samples. Bilateral flow cytometric studies (n = 113 samples) were positive in 11 samples (9.7%; all morphologically positive), with two discrepancies detected between bilateral samples. Bilateral cytogenetic studies (n = 74 samples) were positive in 5 samples (7%), and there were no discrepancies. Bilateral molecular studies (n = 16 samples) were positive in 7 samples (44%), and there were 3 discrepancies.
Bilateral morphologic evaluation is useful in the evaluation of patients with NHL, HD, CA, and SA and is not indicated for patients with acute or chronic leukemia, myelodysplasia, MM, and other diseases. Bilateral flow cytometric or cytogenetic studies of bone marrow did not provide additional information in this population to justify bilateral samples. The role of bilateral molecular analysis needs to be defined further, but pooled samples for molecular studies may be adequate. Cancer 2002;94:1522–31. © 2002 American Cancer Society.