The necessity of bilateral staging bone marrow examinations for paediatric solid tumours

Abstract

Background: Bone marrow aspirates and trephine biopsies (BMATs) form an important part of staging to detect bone marrow metastases of both haematological and nonhaematological neoplasms.Aim: The study’s primary aim was to determine whether it is necessary to perform bilateral BMATs on paediatric cancer patients as opposed to unilateral BMATs for the staging of solid tumours.Setting: The Paediatric Oncology Unit at Universitas Academic Hospital (UAH) in Bloemfontein, Free State, South Africa.Methods: A retrospective descriptive study was performed using laboratory reports from 01 January 2015 to 31 December 2019. Data were collected and reported on regarding the total number of staging BMATs performed, the average length of the trephine biopsies, the number of BMATs used for primary diagnosis, the number of bone marrow specimens where metastases were detected (left, right or both), the type of primary cancer and demographic information.Results: One hundred and eighteen patients were included for interpretation. Bone marrow metastases were detected in 28 patients, of which five patients had discrepant left and right results. These five cases included nephroblastoma (n = 2), Hodgkin lymphoma (n = 2) and a germ cell tumour (n = 1).Conclusion: Discrepant results were found in five cases (n = 28; 17.8%). Ultimately, the clinical implication of incorrectly staging solid tumours outweighs the small risks and discomfort of a bilateral bone marrow biopsy.