Optimum trephine length in the assessment of bone marrow involvement in patients with diffuse large cell lymphoma

Abstract

Morphological bone marrow involvement in DLCL is optimally demonstrated by a 20-mm long trephine biopsy from a single site which is examined at multiple levels (four or more). This obviates the need for bilateral sampling, thereby reducing patient morbidity from the procedure. This study provides evidence to support the National Cancer Institute recommendations regarding trephine biopsy in the staging of DLCL, providing multiple levels are examined.

Role of Immunohistochemistry in Staging Diffuse Large B-cell Lymphoma (DLBCL)

“…It was previously believed that bilateral trephine biopsies increased the yield from staging BMs in NHL (Juneja et al 1990). However, it is now established that bilateral sampling is not required if adequate tissue (including adequate trephine length and number of levels examined) is available for diagnosis (Campbell et al 2003). Our mean trephine length was reasonable at 17.6 mm, with a range of 8-36 mm.…”

“…Two examples where discrete populations of large B cells were noted on immunostaining that were not apparent on careful review of routine histology slides are shown in Figure 3. A previous study by Campbell et al (2003) established that four levels is the optimal number that need to be examined for routine morphological assessment in staging DLBCL. A similar study is required to assess how much of the benefit obtained on immunostaining is caused by examination of multiple levels.…”

“…The reported rates of BM involvement in diffuse large B-cell lymphoma (DLBCL) vary from 12% to 35% (Conlan et al 1990;Campbell et al 2003). Patterns of infiltration vary from subtle focal infiltrates to almost complete effacement by lymphoma cells (Harris et al 1999).…”

“…There is no published literature addressing this issue; this may be because using some of the biopsy specimen for flow cytometric analysis could compromise availability of tissue for histological evaluation. In most cases of NHL, it is recognized that biopsy specimens need to be at least 16 mm in length and that several levels require examination for optimal results (Bain 2001;Campbell et al 2003). Obtaining additional biopsy tissue for flow cytometric analysis may inconvenience the patient significantly.…”

Diagnosis and Classification of Malignant Lymphoma and Related Entities in the Bone Marrow Trephine Biopsy

“…Furthermore, assessment of marrow involvement by histology is not impeded by fibrosis, which is a frequent finding in lymphomatous infiltrates and may lead to false-negative results in BM aspirates due to sampling error [8][9][10] . For these reasons, the performance of a unilateral (or bilateral) BM trephine of adequate size with a minimal length of 2 cm, preferably examined by step sectioning, is regarded mandatory in patients with malignant lymphoma both for the initial determination of BM involvement and response evaluation [11,12] . However, trephine biopsy, aspiration cytology and flow cytometric immunophenotyping should be seen as integral parts of a combined approach ideally resulting in a joint diagnostic assessment [1,3] .…”