The comparative values of bone marrow aspirate and trephine for obtaining bone scan-targeted metastases from hormone-refractory prostate cancer

Abstract

Samples of metastatic prostate cancer to bone are difficult to obtain. The aim of this study was to compare the results of bone marrow aspirate and trephine biopsy for obtaining metastatic hormone-refractory prostate cancer (HRPC) samples using previous diagnostic planar 99 m Tc-HDP bone scans to guide the procedure. All samples taken were for the purposes of research and molecular studies on HRPC. Twenty patients with HRPC had bone marrow aspirate and trephines taken from lesions in the posterior superior iliac spine or sacro-iliac region when shown on diagnostic 99 m Tc-HDP bone scans. Three patients also underwent plain X-ray, 18F-positron emission tomography bone scan, pelvic MRI scan and 99 m Tc nanocolloid bone marrow scans. These images were used to assess if the extra imaging information provided, such as three-dimensional localisation of the bone metastases, was of value for target bone metastases. Cancer cells were obtained in 15/20 (75%) cases in which a trephine biopsy was attempted and 0/20 of cases in which a bone marrow aspiration was attempted. The additional information provided by the range of other imaging investigations was of little benefit in obtaining tumour samples, but did suggest why negative biopsies were obtained in some cases after targeting with planar bone scans. We recommend the use of bone marrow trephine biopsy alone, guided by previous diagnostic 99 m Tc planar bone scan as a practical method to obtain prostate cancer cells from bone metastases. Keywords: 99 m Tc-bone scan; 99 m Tc-nanocolloid bone marrow scan; bone marrow aspiration; bone marrow trephine; Fluorine18 positron emission tomography bone scan; hormone-resistant prostate cancer; pelvic magnetic resonance imaging scan

Amplification of the androgen receptor gene in bone metastases from hormone‐refractory prostate cancer

“…Bone marrow sampling was suggested as a method of achieving this. We have shown here and elsewhere 16 that bone marrow samples can be obtained routinely from HRPC patients and analysed by FISH for AR gene amplification. Studies are now needed to relate AR gene amplification rates in bone metastases to clinical outcome, following the addition of combined androgen blockade treatment.…”

“…Bone metastases have been considered difficult to work with due to the mixture of hard and soft tissue 15. Nevertheless, bone marrow samples can be obtained from most patients 16.…”

Hematological and biochemical predictors of bone marrow metastases in non-hematological malignancies: a clinico-pathological analysis

“…This is consistent with the findings in other studies which have reported the diagnostic superiority of BMB over BMA in cases of solid tumor metastases. 5,6,8 Additionally, bilateral bone marrow examination has been advocated to increase the diagnosis of marrow involvement in many haematological and non-hematological malignancies and was done in 15 cases (68%) in our study. 9 Clinically, the most frequent complaint of the patients in our study was back pain associated with disabled movements in 72% of the patients.…”

Immunohistochemistry- Not As Sensitive As Expected For Detecting Bone Marrow Micrometastases In Cases Of Epithelial Malignancies?

“…As compared to bone metastasis, bone marrow involvement is not very common finding in any epithelial malignancy; but its involvement is a sign of diffuse hematogenous spread of the malignancy. The resulting hematological manifestation of bone marrow spread of tumor like anemia, leukopenia or thrombocytopenia can add up to yield an overall worse prognosis for the patient [9] . Tumor cells commonly metastasize to the most vascularized parts of the skeleton, particularly the red bone marrow of the axial skeleton and the ends of the long bones, the ribs, and the vertebral column [10] .Once tumor cells become housed in the skeleton, cure is no longer possible and only palliative therapy is available.…”

“…Earlier the studies carried out for the detection of bone marrow metastasis were done on large scale and spread over a long duration of 3-5 years follow up basis or retrospectively, investigating past institutional records. Most of the studies with significant results were done on multi-institutional collaboration basis [4,9,13,14,15] . In our study among the different epithelial malignancies taken into consideration majority, 13 cases were of breast malignancy (41.94%), 7 were of gall bladder malignancy, 4 each of lung and gastrointestinal tract malignancy and least cases,3 were of prostate malignancy (9.68%).…”