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Utility of simultaneous assessment of bone marrow aspirates and trephine biopsy sections in various haematological disorders

Authors: Vandana Puri --- Pooja Sharma --- Mrinalini Kotru --- Meera Sikka --- et al.
Journal: Iraq Joural of Hematology المجلة العراقية لامراض الدم ISSN: 20728069/25432702 Year: 2018 Volume: 7 Issue: 1 Pages: 26-32
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

BACKGROUND: Bone marrow examination is crucial diagnostic modality for evaluation of varioushematological and nonhematological disorders. However, marrow aspirate smears and biopsysections, even though performed simultaneously, are often assessed at different points of time dueto different processing methods. This sometimes results in discordance in diagnosis which adds tothe diagnostic dilemma and delays the treatment.AIM: This study aims to compare the diagnostic accuracy and the rate of concordance between thetwo modalities of bone marrow examination.MATERIALS AND METHODS: Three hundred simultaneously performed bone marrow aspiratesand BM trephine biopsies were retrospectively analyzed over a period of 1 year. The presence orabsence of concordance was recorded. The reasons for inconclusive reports were also recorded.The concordance rates for different hematological disorders were calculated and recorded as highfor >80%, moderate for 50%–80%, and low for <50%. The findings of discordant cases and reasonsfor discordance were also tabulated.RESULTS: A high concordance was found in cases of megaloblastic anemia, leukemias,non‑Hodgkin’s lymphoma, and multiple myeloma; moderate concordance was found in hypoplasticmarrow and concordance was low in Hodgkin’s lymphoma, chronic myeloid leukemia (CML) in blastphase, metastatic, and granulomatous involvement of bone marrow.CONCLUSION: Bone marrow aspiration alone is sufficient for the diagnosis of megaloblastic anemiaand most of the hematological malignancies. Bone marrow biopsy is more appropriate for detectionof disorders with focal marrow involvement such as lymphoproliferative disorders, metastatic cancer,focal blast crisis in CML, granulomatous lesions, and hypoplastic marrow. However, it is stronglyrecommended that both should be reviewed simultaneously to ensure maximum diagnostic accuracy.

Keywords

Aspirate --- biopsy --- bone marrow --- concordance

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