title: Bone marrow aspirations and lumbar punctures in retinoblastoma at diagnosis: correlation with IRSS staging.
abstract: BACKGROUND
  Few studies have suggested that routine bone marrow (BM) and cerebrospinal fluid (CSF) evaluation is not needed in all patients with retinoblastoma. Although the International Retinoblastoma Staging System was developed recently, there remain no clear stage-specific guidelines with regard to the need for BM and CSF evaluations as part of the metastatic workup for patients with retinoblastoma.
  
  
  METHODS
  This is a retrospective study analyzing results of CSF cytology and BM evaluation at presentation/diagnosis in patients with retinoblastoma registered at our center from June, 2003 to June, 2009. Only cases with both BM biopsy and lumbar puncture were included.
  
  
  RESULTS
  Of the 259 evaluable patients, 18 (7%) were positive for metastasis either in CSF and/or BM. Although 7 of these had overt metastasis at presentation (stage IV), 1 belonged to stage II and 10 to stage IIIa. No stage 0 or I patient tested positive despite presence of histopathologic high-risk factors.
  
  
  CONCLUSIONS
  This is the largest study evaluating the role of metastatic workup in patients with retinoblastoma at presentation. We conclude that CSF and BM evaluation is not required in patients with stage 0 and I retinoblastoma at presentation. No definitive recommendation could be made for stage II patients; while stage III and IV patients must certainly be evaluated.
authors.affiliation: Department of Medical Oncology, Dr B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India. sambakh@hotmail.com
authors.forename: Sameer
authors.initials: S
authors.lastname: Bakhshi
authors.forename: Rachna
authors.initials: R
authors.lastname: Meel
authors.forename: Seema
authors.initials: S
authors.lastname: Kashyap
authors.forename: Sanjay
authors.initials: S
authors.lastname: Sharma
mesh_terms: D000293:Adolescent; D001707:Biopsy, Needle / Q000592:standards*; D001854:Bone Marrow Cells / Q000473:pathology*; D001859:Bone Neoplasms / Q000134:cerebrospinal fluid / Q000401:mortality / Q000556:secondary*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009367:Neoplasm Staging / Q000379:methods; D017410:Practice Guidelines as Topic; D019572:Retinal Neoplasms / Q000134:cerebrospinal fluid / Q000401:mortality / Q000473:pathology*; D012175:Retinoblastoma / Q000134:cerebrospinal fluid / Q000401:mortality / Q000556:secondary*; D012189:Retrospective Studies; D012307:Risk Factors; D013129:Spinal Puncture / Q000592:standards*; D019564:Unnecessary Procedures