A systematic study comparing aspirate <i>versus</i> trephine for quantifying plasma cell infiltration in newly‐diagnosed myeloma

Gabriel, Joseph; McGovern, Andrew; Robinson, Stephen; Wright, David; Chevassut, Timothy

doi:10.1111/bjh.13807

Cited by 4 publications

(2 citation statements)

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“…In fact, 74% of cases that would have been classified as MGUS by smear morphology already fulfilled the criteria for plasma cell myeloma on histomorphologic examination. Similar rates of misclassification of MGUS by aspirate smear counts have also been observed by others [ 12 , 13 ]. At the threshold level of ≥ 60% plasma cells on the core biopsy, more than half of our cases would have been missed by the smear count.…”

Section: Discussionsupporting

confidence: 87%

“…Plasma cell percentages obtained by estimates from core biopsies were substantially higher than plasma cell percentages obtained by counts from aspirate smears, irrespective of the quality of the biopsy specimen. This is a well-known phenomenon, and it is therefore aspirate smear counts have also been observed by others [12,13]. At the threshold level of ≥ 60% plasma cells on the core biopsy, more than half of our cases would have been missed by the smear count.…”

Section: Discussionsupporting

confidence: 79%

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Biological properties of bone marrow plasma cells influence their recovery in aspirate specimens: impact on classification of plasma cell disorders and potential bias to evaluation of treatment response

et al. 2020

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Methods to estimate bone marrow plasma cells (BMPC) basically include histopathology, cytomorphology, and flow cytometry. The present study compares the outcomes of these methods with special focus on the impact of BMPC-specific characteristics on their recovery by either method. Laboratory reports of diagnostic samples from 238 consecutive patients with suspected or known plasma cell disease were retrospectively analyzed. The median (IQR) proportion of BMPC was 30.0% (15.0–70.0%) by histological review (hBMPC), 7.0% (2.0–16.0%) by smear review (sBMPC), and 3.0% (0.8–10.0%) by flow cytometry (fBMPC). The disparity of results between core biopsy and aspirate smear was enhanced in case of poor quality of the smear, increased BM fiber content, higher grade cell atypia, expression of CD56 (all P < 0.0001), the number of cytogenetic aberrations (P = 0.0002), and abnormalities of the MYC gene (P = 0.0002). Conversely, expression of CD19 and a non-clonal plasma cell phenotype were associated with a lower difference between hBMPC and sBMPC (both P < 0.0001). The disparity between the percentages of sBMPC and fBMPC was associated with the quality of the smear (P = 0.0007) and expression of CD56 (P < 0.0001). Our results suggest that the recovery of BMPC in aspirate specimens not only is a matter of sampling quality but also depends on biological cell properties. Aspiration failure due to malignant type features of BMPC may lead to misclassification of plasma cell disorders and represent a bias for the detection of minimal residual disease after therapy.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 79%