Trephine needle bone marrow biopsy in the initial staging of Hodgkin disease: Sensitivity and specificity of the ann arbor staging procedure criteria

Abstract

The purpose of this study was to test the value of the Ann Arbor staging procedures committee criteria in defining a group of newly diagnosed patients with Hodgkin disease who do not have involvement of the bone marrow and do not need this procedure performed. One hundred sixty-six bilateral and 16 unilateral trephine bone marrow biopsies were performed in a consecutive series of 182 patients undergoing initial staging for Hodgkin disease. Bone marrow involvement was found in 13 patients. Advanced stage, defined as stage III or IV, occurring in 92%, anemia occurring in 100%, and "B" symptoms present in 100% were found to be the most sensitive indicators for bone marrow involvement. Osseous disease (99%), platelet count less than 150,000/mm3 (98%), and WBC less than 4,800/mm3 (94%) were the most specific parameters. The known association of bone marrow involvement with older patients, lymphocyte depleted histology, lower blood cell counts, anemia, advanced stage, and poorer survival is verified. The Ann Arbor staging procedures committee criteria for performing a bone marrow biopsy were shown to be 100% sensitive and 40% specific. Use of these criteria would have found all 13 patients with bone marrow involvement. Of the 73 patients who did not meet the criteria, no patient had bone marrow involvement. Use of the Ann Arbor staging procedures committee criteria is recommended.

Bone marrow trephine biopsy

“…Trephine biopsy is not mandatory in the staging of Hodgkin's disease diagnosed at another site. 4 In one series, management was altered by the results of biopsy in less than 1% of patients. 5 Management of the patient will not be altered if it is already known that the patient has stage III or IV disease or if, for any other reason, treatment by chemotherapy is intended.…”

Development and validation of a clinical prediction rule for bone marrow involvement in patients with Hodgkin lymphoma

“…Only a single study has evaluated the validity of these criteria. 4 If the presence of at least 1 of these factors were considered as indication for bone marrow biopsy, the sensitivity for the detection of BMI was 100% and the specificity 40%. Furthermore, according to the updated criteria for staging of HL, established during the Cotswolds meeting in 1988, 12 a bone marrow biopsy from at least 1 site is recommended for patients with clinical stage III/IV as well as for clinical stage II with adverse features.…”

“…Conversely, patients with relatively high risk of BMI might benefit from bilateral trephine biopsy, because the probability of demonstrating BMI can be increased by 16% to 33%, if bilateral biopsy is performed. 4,14,15 In the present study we evaluated various conventional demographic, clinical, and laboratory factors to identify independent predictors for BMI and to define subgroups of patients, who might avoid trephine biopsy or benefit from bilateral biopsy.…”

Extensive Bone Marrow Involvement in Hodgkin Lymphoma Patient / Ekstenzivno Zahvatanje Koštane Srži Kod Bolesnika Sa Hočkinovim Limfomom

“…Patients with low risk for BMI could be spared from such procedure. Conversely, patients with relatively high risk of BMI might benefit from bilateral trephine biopsy, because the probability of demonstrating BMI can be increased by 16% to 33% if bilateral biopsy is performed (2,7,8). Vassilakopoulos et al published a clinical prediction rule for BMI in HL based on 826 patients and validated it in 654 additional patients (9).…”

“…Its incidence varies between 4% and 14% in the series reported during the past 20 years (1)(2)(3). According to the Ann Arbor staging criteria for HL, a bone marrow biopsy (BMB) is recommended for patients with any of the following: elevated serum alkaline phosphatase, stage III/IV disease, any unexplained cytopenia or radiographic/scintigraphic evidence of osseus involvement (4).…”