Questioning the need for routine bone marrow aspiration and lumbar puncture in patients with retinoblastoma.
OBJECTIVE
This study assesses the value of routinely investigating children with retinoblastoma with bone marrow aspiration and lumbar puncture, staging investigations not without risk and trauma to the patient, emotional stress on parents and financial cost to the community.


METHODS
Medical files and specimens were obtained and examined for patients with retinoblastoma presenting to the Royal Alexandra Hospital for Children, Camperdown and the Children's Hospital at Westmead, Sydney, from 1975 to 2001.


RESULTS
In total, 123 patients presented; 62 (50.4%) were boys and 61 (49.6%) were girls. Of these 123 patients, 74 (60.2%) had unilateral disease, 46 (37.4%) involving the left eye and 28 (22.8%) involving the right eye. There were 47 (38.2%) patients with bilateral disease, and two (1.6%) with trilateral disease. Mean age of presentation was 17.9 months (23.1 months for unilateral subjects; 10.3 months for bi-lateral subjects; 3.5 months for trilateral subjects). There were 13 (10.6%) with a positive family history. Of 74 unilateral subjects, 70 (94.6%) required enucleation and four (5.4%) were salvaged. Of 47 bilateral subjects, 13 (27.7%) did not require enucleation, 27 (57.4%) required unilateral enucleation and seven (14.9%) required bilateral enucleation. Both trilateral subjects died. Of all 123 subjects, 112 (91.1%) had bone marrow aspiration and lumbar puncture performed during initial assessment, and none showed evidence of malignancy.


CONCLUSIONS
Given the small but significant risks associated with these procedures, the results of this study cannot support bone marrow aspiration and lumbar puncture as routine investigations in all patients presenting with retinoblastoma, suggesting a more limited usage of these investigations is warranted.
Azar
Domit
D
Children's Hospital at Westmead, Sydney, New South Wales, Australia. domitazar@hotmail.com
Donaldson
Craig
C
Dalla-Pozza
Luciano
L
D001707:Biopsy, Needle; D001853:Bone Marrow / Q000473:pathology; D001856:Bone Marrow Examination; D003941:Diagnostic Techniques, Ophthalmological; D003955:Diagnostic Tests, Routine; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009367:Neoplasm Staging; D019572:Retinal Neoplasms / Q000134:cerebrospinal fluid / Q000473:pathology*; D012175:Retinoblastoma / Q000134:cerebrospinal fluid / Q000473:pathology*; D012449:Safety; D013129:Spinal Puncture