DIAGNOSTIC AND PROGNOSTIC SIGNIFICANCE OF BONE MARROW BIOPSY IN NON HODGKINS LYMPHOMA

Abstract

Background: Trephine bone marrow biopsy is the standard method for the
diagnosis of neoplasia. In the last few years its role has been defined further by
the widespread introduction of immunohistochemistry (IHC), the method that
increased the diagnostic power of the trephine bone marrow biopsy by
detecting specific antigens in the tumor tissue using nonflourescent
chromogens that can be seen by conventional microscopy. Objective: to
evaluate the diagnostic and prognostic significance of bone marrow biopsy in
non-Hodgkin's lymphomas. Correlation of bone marrow biopsy finding with
other prognostic markers in non-Hodgkin’s lymphomas is another aim.
Methods: The study was performed on 50 patients of NHL diagnosed by LN
histopathology. All patients were subjected to: clinical examination and
laboratory investigations including complete blood picture, liver function tests,
kidney function tests, Erythrocyte sedimentation rate, serum lactate
dehydrogenase, B2 microglobulin, bone marrow aspiration,
immunophenotyping of bone marrow aspiration of the disseminated cases,
bone marrow trephine biopsy for: histological classification according to
WHO, staging of NHL and Immunohistochemical staining for CD3 and CD20.
Results: Twenty patients (40%) positive for infiltration on examination of
marrow biopsy and 30 patients (60%) were negative. The results of fifty NHL
cases showed only in six cases, both bone marrow biopsy and aspiration were
positive (12%; 95% CI, 4.0: 22.0), and in 30 out of 50, the two parameters
were negative (60%, 95%CI, 46: 54). Thus, the agreement level between BMB
and BMA in the diagnosis of NHL was 27% and discrepancies between bone
marrow biopsy and aspirate were found in the remainder. In 14 of 50
specimens, BMB alone was positive (28%; 95% CI, 16 : 42). Conclusion:
Bone marrow biopsy morphology and immunohistochemical staining remain
the cornerstone for proper staging in NHL patients to increase the diagnostic
and prognostic accuracy, for appropriate treatment protocols.
Key words: NHL, non Hodgkin's lymphoma, BMB, Bone marrow biopsy.
BMA, bone marrow aspiration and IHC, immunohistochemistry, diagnosis,
prognosis.