title: An Evidence-based Recommendation for a Standardized Approach to Detecting Metastatic Neuroblastoma in Staging Bone Marrow Biopsies.
abstract: Neuroblastoma is a common malignant tumor of childhood. Accurate bone marrow (BM) evaluation for metastatic tumor is essential; however, no standardized pathologic workup exists for staging BMs. We examined the diagnostic yield of various BM components and optimal core biopsy (CB) length as part of developing evidence-based recommendations for BM evaluation. After obtaining institutional review board approval, 160 BM biopsies from 50 neuroblastoma patients were retrospectively selected. Hematoxylin and eosin-stained CB and Wright-stained aspirates were scored as positive, negative, or indeterminate. Total/trabecular CB lengths were measured using cellSens software and a DP71 camera (Olympus). Of the 160 BMs, 72 were positive for tumor in any component. Of these, 33 (45.8%) were positive in a single portion of the specimen: 19 CBs and 14 aspirates. Compared with overall diagnosis, sensitivities were as follows: CB 76.3%; aspirate 67.1%; core/aspirate combined 94.7%. Diagnostic CBs had significantly longer trabecular length than nondiagnostic CBs (6.74 mm vs 4.03 mm, P = .006). Positive CBs had longer trabecular space than negative marrows (7.91 mm vs 6.25 mm, P = .002). Nearly 50% of our positive specimens showed diagnostic discordance among the various components examined. However, combining CB and aspirate examination improved sensitivity for tumor detection. We therefore recommend bilateral CBs (>1 cm each) and aspirates for the optimal evaluation of BM for metastatic neuroblastoma.
authors.affiliation: 1 Department of Pathology, Medical College of Wisconsin, Wisconsin, USA.
authors.forename: L N
authors.initials: LN
authors.lastname: Parsons
authors.affiliation: 1 Department of Pathology, Medical College of Wisconsin, Wisconsin, USA.|2 Children's Hospital of Wisconsin, Wisconsin, USA.
authors.forename: G
authors.initials: G
authors.lastname: Gheorghe
authors.affiliation: 3 Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: K
authors.initials: K
authors.lastname: Yan
authors.affiliation: 3 Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: P
authors.initials: P
authors.lastname: Simpson
authors.affiliation: 1 Department of Pathology, Medical College of Wisconsin, Wisconsin, USA.|2 Children's Hospital of Wisconsin, Wisconsin, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Jarzembowski
mesh_terms: D000293:Adolescent; D062005:Biopsy, Large-Core Needle; D001853:Bone Marrow / Q000473:pathology*; D001859:Bone Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000556:secondary*; D002648:Child; D002675:Child, Preschool; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009367:Neoplasm Staging; D009447:Neuroblastoma / Q000175:diagnosis / Q000473:pathology / Q000556:secondary*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
keywords: aspiration; bone marrow; core biopsy; neuroblastoma; staging