title: Combined evaluation of bone marrow aspirate and biopsy is superior in the prognosis of multiple myeloma.
abstract: BACKGROUND
  Estimation of plasma cell infiltrates in bone marrow aspirates (BMA) and bone marrow biopsy (BMB) is a standard method in the diagnosis and monitoring of multiple myeloma (MM). Plasma cell fraction in the bone marrow is therefore critical for the classification and optimal clinical management of patients with plasma cell dyscrasias. The aim of the study was to compare the percentage of plasma cells obtained by both methods with the patient clinical parameters and survival.
  
  
  METHODS
  This retrospective study included BMA and BMB of 59 MM patients. The conventional differential count was determined in BMA to estimate the percentage and cytologic grade of plasma cells. The pattern of neoplastic infiltration and percentage of plasma cells were estimated on CD138 immunostained BMB slides microscopically and by computer-assisted image analysis (CIA).
  
  
  RESULTS
  Significantly higher values of plasma cell infiltrates were observed in pathologist (47.7 +/- 24.8) and CIA (44.1 +/- 30.6) reports in comparison with cytologist analysis (30.6 +/- 17.1; P < 0.001 and P < 0.0048, respectively). BMB assessment by pathologist counting and using CIA showed strongest correlation (r = 0.8; P < 0.0001). Correlation was also observed between the pathologist and cytologist counts (r = 0.321; P = 0.015) as well as comparing the percentage of plasma cells in BMA and CIA (r = 0.27; P = 0.05). Patients with clinical stage I/II had a significantly lower CIA plasma cell count than those with clinical stage III (P = 0.008). Overall survival was shorter in patients with more than 25% of atypical plasma cell morphology estimated in BMA (P = 0.05) and a higher percentage of tumor cell infiltrates estimated by the pathologist and CIA (P = 0.0341 and P = 0.013, respectively).
  
  
  CONCLUSIONS
  Study results suggested the combined analyses to be useful as a routine procedure to achieve more accurate and informative diagnostic data.
authors.affiliation: Department of Pathology, School of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia.
authors.forename: Sanja
authors.initials: S
authors.lastname: Stifter
authors.forename: Emina
authors.initials: E
authors.lastname: Babarović
authors.forename: Toni
authors.initials: T
authors.lastname: Valković
authors.forename: Irena
authors.initials: I
authors.lastname: Seili-Bekafigo
authors.forename: Christophe
authors.initials: C
authors.lastname: Stemberger
authors.forename: Antica
authors.initials: A
authors.lastname: Nacinović
authors.forename: Ksenija
authors.initials: K
authors.lastname: Lucin
authors.forename: Nives
authors.initials: N
authors.lastname: Jonjić
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001707:Biopsy, Needle; D001853:Bone Marrow / Q000276:immunology / Q000473:pathology*; D001856:Bone Marrow Examination / Q000379:methods*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D010950:Plasma Cells / Q000276:immunology / Q000473:pathology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D053668:Syndecan-1 / Q000032:analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: C508241:SDC1 protein, human; D053668:Syndecan-1