Correlation Of Bone Marrow Aspiration And Trephine Biopsy In Various Haematological Disorders: A Study Of 3 Years
Keywords:
Bone Marrow Aspirate, Bone Marrow Biopsy, Correlation, Myelofibrosis, Niemann Pick Diseases, Gaucher’s Disease, Metastatic breast Carcinoma, Small Round Blue Cell Tumor.Abstract
Background: The bone marrow examination is an essential investigation for the diagnosis and management of many disorders of the blood and bone marrow. The aspirate and trephine biopsy specimens are complementary and when both are obtained, they provide a comprehensive evaluation of the bone marrow. The present study was conducted to compare the role of trephine biopsy with bone marrow aspiration for effectively diagnosing wide spectrum of hematological diseases. Few studies have compared the relative value of aspirate with trephine biopsy.
Materials & method: This is a three year observational study undertaken in Dept. of Pathology, MKCG MCH, Berhampur,Odisha. A total of 370 cases presented with haematological disorders, of which only 126 patients had undergone trephine biopsy and correlation was done with aspiration in these patients.
Results: Of a total 370 patients, both BMA & BMB were performed on 126 patients (71 male & 55 female). Commonly encountered diseases were AML (17%), IDA (11%), ALL (9%), others (9%), CML (8%), MA (6%) accounted for maximum no. of cases. Others group included TB, NPD, Metastatic Diseases such as SRBCT, NHL& Neuroblastoma. Patients from 2 months to 80 years old were encountered in the study. BMB was diagnostic in 100% cases. In comparison BMA, a positive diagnosis was made in 80% (101) cases, suggestive in 6.3%(8) cases &negative in 13.4% (17) cases. BMB was superior to BMA in diagnosis of MF (2%), ALL (4%), Others (9%) where BMA aspirations yielded a dry tap / diluted marrow. In the present study BMB was advantageous in diagnosis & staging in 19%(25) cases. Additional advantages of BMB noted in the present study were assessment of cellularity, detection of ALIP, assessment of fibrosis, nodular/diffuse/focal patterns of involvement, metastatic deposits, and granuloma could be identified in BMB.
Conclusion: The decision whether to perform a BMA alone or in combination with BMB rests on the diagnostic possibilities. In IDA, ITP & Acute leukaemia’s where cellular morphology is desired aspiration is best. BMB is superior when assessment of cellularity, detection of ALIP, assessment of fibrosis, nodular/diffuse/focal patterns of involvement, metastatic deposits, granuloma, with the use of IHC on BMB samples the accuracy in diagnosis of Lymphoma, AML/ALL, MM & Metastatic Diseases can be made. Thus BMA & BMB should always go hand in hand.
DOI:10.21276/APALM.1627
References
2. Ch Toi P, Varghese G’Boy R, Rai R. Comparative evaluation of simultaneous bone marrow aspiration and bone marrow biopsy. An institutional experience. Indian J Hematol Blood Transfus. 2010;26(2):41–44.
3. Lee SH, Erber WN, Porwit A, Tomonga M, et al. ICSH guidelines for the standardization of bone marrow specimens and reports. Int. Jnl. Lab. Hem. 2008;30:349–64.
4. Islam A. Bone marrow aspiration prior to bone marrow core biopsy using the same bone marrow biopsy needle. A good or bad practice. J Clin Pathol. 2007;60:212–15.
5. Knodke K, Marwah S, Buxi G, Yadav RB, Chaturvedi NK. Bone marrow examination in cases of Pancytopenia. J Academy Clin Med 2001;2:55-59.
6. Jha A, Sayami G, Adhikari RC, Panta D, Jha R. Bone marrow examination in a case of pancytopenia. J Nepal Med Assoc 2008;47:12-17.
7. Stuart_SE, Hughes DA, Bain BJ. Are routine iron stains on bone marrow trephine biopsy specimens necessary? J Clin Pathol. 2005;58(3):269-72.
8. Sabharwal BD, Malhotra VV, Aruna SS, Grewal RR. Comparative evaluation of bone marrow aspirate particle smears, imprints and biopsy sections. J Postgrad Med 1990;36:194-98.
9. Charles KS, Winfield DA, Angel C, Goepel J. Audit of bone marrow aspirates and trephine biopsies in multiple myeloma-a single centre study. Clin Lab Hematol 2004; 26:403-06.
10. James D, Bearden, Gary A, Ratkin,Charles AC. Comparison of the diagnostic value of bone marrow biopsy and bone marrow aspiration in neoplastic disease. J Clin Pathol 1974;27:738- 40.
11. Sudha HM, Krishnappa R, Rishi B. Correlation of Bone Marrow Aspirate, Biopsies and Touch Imprint Findings in Pancytopenia. J Hematol 2013;2(1):8-13
12. Kim YS, Ford RJ, Faber JA. B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma involving bone marrow with an interfolicular pattern. Am J Clin Pathol. 2000;114(1):41-46.
13. Gupta V, Tripathi S, Tilak V, Bhatia BD. A study of clinico- haematological profiles of pancytopenia in children. Trop Doct. 2008;38(4):241-43.
14. Humphries JE. Dry tap bone marrow aspiration: clinical significance. Am J Hematol. 1990;35(4):247-50.
15. Goyal S, Singh UR, Rusia U. Comparative Evaluation of Bone Marrow Aspirate with Trephine Biopsy in Hematological Disorders and Determination of Optimum Trephine Length in Lymphoma Infiltration. Mediterr J Hematol Infect Dis. 2014;6(1):e2014002. doi: 10.4084/MJHID.2014.002. eCollection 2014.
16. Santra G, Das B K. A cross-sectional study of the clinical profile and aetiological spectrum of pancytopenia in a tertiary care centre. Singapore Med J 2010;51:806-12. PMid:21103817
17. Parajuli S, Tuladhar A. Correlation of bone marrow aspiration and biopsy findings in diagnosing hematological disorders – a study of 89 cases. Journal of Pathology of Nepal 2014;4:534 -38.
18. Smita C, Harish C. Comparison of bone marrow aspirate cytology, touch imprint cytology and trephine biopsy for bone marrow evaluation. Hematology Reports 2011;3(22):65-68.
19. Surbhi G, Usha RS, Usha R. Comparative Evaluation of Bone Marrow Aspirate with Trephine Biopsy in Hematological Disorders and Determination of Optimum Trephine Length in Lymphoma Infiltration. Mediterr J Hematol Infect Dis 2014, 6(1): e2014002, DOI: 10.4084/MJHID.2014.002.
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Copyright (c) 2018 Manoj Kumar Patro, T Santosh, Atanu Kumar Bal, Anita Choudhury, Jayanti Nayak, Bodhisatwa Behera, Debi Prasad Mishra
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