title: Audit of bone marrow aspirates and trephine biopsies in multiple myeloma--a single centre study.
abstract: We compared 79 simultaneous marrow aspirates and trephine biopsies from multiple myeloma patients for sensitivity, concordance, quality and clinical relevance. A total of 60 examinations had been performed for initial diagnosis, i.e. in cases of suspected myeloma and 19 at follow-up. Of which, 45 (57%) of trephine biopsies were less than 1.6 cm before processing and 33 (42%) were crushed and/or fragmented. Overall, only 19/79 (24%) of trephine biopsy specimens were of at least 1.6 cm length prior to processing and not disrupted. On the other hand, 75% of aspirates were particulate and satisfactory. Mean time between receipt of a trephine biopsy specimen and issuance of a histopathological report was 9 days. Although 40% of trephine biopsies yielded information that could not be reliably obtained from a bone marrow aspirate such information was in all cases clinically irrelevant or obtainable by non-invasive means. In all cases where myeloma was detected in a trephine biopsy it was also detected in a simultaneous bone marrow aspirate, if particulate. However, there were four (5%) cases in which myeloma was detected in such aspirates but not in simultaneously taken trephine biopsies. In cases (n=19) where repeat aspirates/trephine biopsies were taken for surveillance, concordance was found between reported changes in plasma cell ratio. Our data failed to demonstrate any added benefit from routinely performing trephine biopsies after a particulate specimen had been aspirated for the diagnosis or surveillance of myeloma. Furthermore, they suggest that particulate aspirates may be at least as sensitive as trephine biopsies for detecting myeloma.
authors.affiliation: Department of Haematology, General Hospital, Charlotte Street, Port of Spain, Trinidad, West Indies. skcharles58@hotmail.com
authors.forename: K S
authors.initials: KS
authors.lastname: Charles
authors.forename: D A
authors.initials: DA
authors.lastname: Winfield
authors.forename: C
authors.initials: C
authors.lastname: Angel
authors.forename: J
authors.initials: J
authors.lastname: Goepel
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D001853:Bone Marrow / Q000737:chemistry* / Q000473:pathology*; D005260:Female; D006403:Hematologic Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000473:pathology; D012189:Retrospective Studies