Comparison of Relative Value of Bone Marrow Aspirates and Bone Marrow Trephine Biopsies in the Diagnosis of Solid Tumor Metastasis and Hodgkin Lymphoma: Institutional Experience and Literature Review

Abstract

Context.—Bone marrow aspirates as well as bone marrow trephine biopsies are frequently performed to assess whether there is marrow involvement by a malignancy. Numerous reports differ in the relative value of these 2 procedures and fail to provide concise guidelines that can help choose the appropriate technique in this clinical situation. Objective.—To compare the relative value of aspirates and trephine biopsies in the diagnosis of solid tumor metastasis and Hodgkin lymphoma. In addition, we correlate our findings with those of the literature to provide a concise practice guideline. Design.—Sixty-six cases showing bone marrow involvement by solid tumor and Hodgkin lymphoma in bone marrow aspirates, bone marrow trephine biopsies, or both were included in the study. The diagnosis and findings made on aspirates were compared with those made on trephine biopsies in each case. Results.—In those cases where both aspirate and trephine biopsy were available for evaluation, there was a 22% positive correlation in the findings on aspirates and trephine biopsies. The correlation between aspirates and trephine biopsies was highest in cases of small cell carcinoma of the lung (3/11, or 36.3%) followed by breast carcinoma (7/20, or 35%), prostate carcinoma (1/9, or 11.1%), and Hodgkin lymphoma (1/20, or 5%). Two of 5 cases from the miscellaneous category demonstrated simultaneous involvement of aspirate and trephine biopsy by a gastric carcinoma as well as an adrenal gland carcinoma. Conclusions.—Bone marrow aspirate and bone marrow trephine biopsy should both be performed in patients with proven or suspected malignancies where staging may affect management. However, bone marrow aspirate has only a minimal role, if any, in detecting bone marrow involvement by Hodgkin lymphoma. In cases of breast carcinoma, small cell carcinoma of lung, and prostate carcinoma, aspirate evaluation may confirm trephine biopsy results or, more rarely, provide the sole confirmation of the malignancy.

Bone Marrow Involvement in Non-Hodgkin Lymphoma at Diagnosis

“…Another 1 of these (3.33%), BMB was negative, whereas morphological analysis in the bone marrow aspirate was regarded as positive. This finding is in agreement with reported cases of true-positive bone marrow aspirates with negative biopsies in nonhematological neoplasms (frequency range, 2-12%) 12,13 Therefore, although BMA will only rarely provide information not available by BMB, abandoning aspirates in these instances might result in missing bone marrow infiltration in a small percentage of cases. In addition, although the role of immunophenotypical analysis by flow cytometry for staging or restaging of NHL is not well defined, it might increase the sensitivity of bone marrow involvement by NHL over morphological evaluation alone in the bone marrow aspirates.…”

An Extensive Analysis and Comparison of Bone Marrow Aspiration and Bone Marrow Trephine Biopsy at a Tertiary Care Hospital in Jharkhand for Various Hematological and Non-hematological Illnesses

“…One patient clinically suspected of tuberculosis was found to have Hodgkin's disease through trephine biopsy, while BMA showed reactive marrow. These findings align with Moid et al, who reported a 95% diagnosis of Hodgkin's disease using trephine biopsy alone, and Howell et al, who noted that marrow aspiration did not significantly aid in detecting marrow involvement in Hodgkin's disease [23,24]. Similarly, Sharma et al reported diagnosing Hodgkin's disease solely through trephine biopsy [25].…”

Diagnostic importance of bone marrow aspiration evaluation: A single-center study

“…10 Although cell morphologies were adequately evaluated with BMA, in malignancies with focal Bone marrow aspiration evaluation involvement, such as lymphoma and multiple myeloma, the diagnosis is made based on BMB when there are not sufficient particles with aspiration or diagnostic cells. 12,13 In our study, the results of BMA and BMB were fully consistent in the diagnosis of 44 (8.8%) patients with multiple myeloma. However, three (0.8%) patients with multiple myeloma could not be diagnosed with BMA due to focal involvement or insufficient particles, and the diagnosis was made using BMB.…”