Diagnostic and Prognostic Significance of Bone Marrow Biopsy in Non Hodgkins Lymphoma

Abstract

Background: Trephine bone marrow biopsy is the standard method for the diagnosis of neoplasia. In the last few years its role has been defined further by the widespread introduction of immunohistochemistry (IHC), the method that increased the diagnostic power of the trephine bone marrow biopsy by detecting specific antigens in the tumor tissue using nonflourescent chromogens that can be seen by conventional microscopy. Objective: to evaluate the diagnostic and prognostic significance of bone marrow biopsy in non-Hodgkin's lymphomas. Correlation of bone marrow biopsy finding with other prognostic markers in non-Hodgkin's lymphomas is another aim. Methods:The study was performed on 50 patients of NHL diagnosed by LN histopathology. All patients were subjected to: clinical examination and laboratory investigations including complete blood picture, liver function tests, kidney function tests, Erythrocyte sedimentation rate, serum lactate dehydrogenase, B2 microglobulin, bone marrow aspiration, immunophenotyping of bone marrow aspiration of the disseminated cases, bone marrow trephine biopsy for: histological classification according to WHO, staging of NHL and Immunohistochemical staining for CD3 and CD20. Results: Twenty patients (40%) positive for infiltration on examination of marrow biopsy and 30 patients (60%) were negative. The results of fifty NHL cases showed only in six cases, both bone marrow biopsy and aspiration were positive (12%; 95% CI, 4.0: 22.0), and in 30 out of 50, the two parameters were negative (60%, 95%CI, 46: 54). Thus, the agreement level between BMB and BMA in the diagnosis of NHL was 27% and discrepancies between bone marrow biopsy and aspirate were found in the remainder. In 14 of 50 specimens, BMB alone was positive (28%; 95% CI, 16 : 42). Conclusion: Bone marrow biopsy morphology and immunohistochemical staining remain the cornerstone for proper staging in NHL patients to increase the diagnostic and prognostic accuracy, for appropriate treatment protocols.