Correlation Of Bone Marrow Aspiration And Trephine Biopsy In Various Haematological Disorders: A Study Of 3 Years

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 only126 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 (71male & 55 female). Commonly encountered diseases were AML (17%), IDA (11%), ALL (9%), others (9%), CML (8%), (6%) accounted for maximum number of cases. Other conditions 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 Abnormal localization of immature precursors,, 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, Multiple myeloma & Metastatic Diseases can be made. Thus BMA & BMB should always go hand in hand.

Bone marrow aspiration versus trephine biopsy: diagnostic value of both modalities when done simultaneously.

“…3 Same data is proposed by Pori V in 2018, Sajjan N in 2015, Patro MK in 2018, and Kaur M in 2014. 1,2,5,19 In study done by Humphries, it was found that cases with dry tap on bone marrow aspirate showed myelofibrosis when their trephine biopsies were examined. 20 Thus, if aspirate gives a dry tap, the hematologist should not assumed that it is because of the faulty procedure, but should prompt the hematologist to examine the trephine biopsy.…”

“…Similar recommendations are suggested in literature. 2,5,24,25 The diagnostic significance of one exceed the other, depending on the nature of underlying hematological disorder.…”

“…Examination of bone marrow samples is an important test to make diagnosis of a wide spectrum of hematological diseases. [1][2][3][4][5] There are a number of diseases that cannot be diagnosed without doing bone marrow biopsy. [6][7][8][9][10][11] It is the first investigation done if patient has unexplained cytopenias or hepatosplenomegaly.…”

“…15 When both are done together, they complement each other, and thus guide the hematologist to a particular diagnosis with more accuracy. 2,16 In routine practice, both the types of specimens are taken in the same time, and examined simultaneously. 2,3,17 In certain setups, facilities for processing of the trephine biopsy sample are not available.…”

“…2,16 In routine practice, both the types of specimens are taken in the same time, and examined simultaneously. 2,3,17 In certain setups, facilities for processing of the trephine biopsy sample are not available. So, examination of only bone marrow aspirate is done, and patient is advised to do bone marrow trephine biopsy later.…”