title: Recommendations for the use of routine bone marrow aspiration and lumbar punctures in the follow-up of patients with retinoblastoma.
abstract: OBJECTIVE
  Patients with metastatic retinoblastoma have a poor outcome. Hope that early detection of extraocular spread will improve survival has led to routine monitoring with bone marrow and cerebrospinal fluid (CSF) examinations. In light of cost and patient morbidity, the clinical utility of this practice is questioned.
  
  
  METHODS
  We have performed 254 serial bone marrow aspirations and 164 lumbar punctures in 60 children with retinoblastoma.
  
  
  RESULTS
  Two patients with extensive intraocular disease at diagnosis developed positive bone marrow aspirations, although no patient died of distant metastasis. Three patients developed positive CSF examinations. All had neurologic symptoms at the time of CSF positivity.
  
  
  CONCLUSIONS
  We recommend performing staging bone marrow and CSF evaluations only in patients with clinical, histologic, or radiologic evidence of local or systemic extension (Pratt stage III-IV), or in patients presenting with one Reese-Ellsworth group V eye and retrolaminar or extrascleral extension of their tumor. We recommend limiting follow-up bone marrow and CSF evaluations to patients who develop objective signs and symptoms of metastatic or regionally recurrent disease.
authors.affiliation: Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa 33612, USA.
authors.forename: L C
authors.initials: LC
authors.lastname: Moscinski
authors.forename: T W
authors.initials: TW
authors.lastname: Pendergrass
authors.forename: A
authors.initials: A
authors.lastname: Weiss
authors.forename: E
authors.initials: E
authors.lastname: Hvizdala
authors.forename: K S
authors.initials: KS
authors.lastname: Buckley
authors.forename: R E
authors.initials: RE
authors.lastname: Kalina
mesh_terms: D001707:Biopsy, Needle; D001853:Bone Marrow / Q000473:pathology*; D002675:Child, Preschool; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009367:Neoplasm Staging; D012175:Retinoblastoma / Q000134:cerebrospinal fluid* / Q000473:pathology* / Q000556:secondary; D013129:Spinal Puncture