Comparative Evaluation of Simultaneous Bone Marrow Aspiration and Trephine Biopsy - Experience From Routine Hematology Practice.

ABSTRACT

Background: A bone marrow evaluation encompasses bone marrow aspirate (BMA) and bone marrow biopsy (BMB) along with a review of peripheral smear examination. However, due to variations in practice, bone marrow core biopsy is not performed for all patients. Aim: To compare the diagnostic utility of simultaneous BMA and BMB and to study the concordance rate between the two. Material and methods: All BMA and BMB that were simultaneously done between January 2008 and December 2010 in a multispecialty hospitals were reviewed and analyzed in detail. Results: Four hundred sixty-six aspiration and biopsy slides were reviewed. The commonest indication was anemia (40.3%) followed by pyrexia of unknown origin (36.2%); 15.2% aspirates and 6.4% biopsies were inadequate. The overall concordance rate between aspirates and biopsy was found to be 62.8%. Concordance was highest for acute and chronic leukemias, metastatic deposits, multiple myeloma and tuberculosis and least for lymphoproliferative disorders, myelofibrosis and marrow hypoplasia. Trephine biopsy was useful for patients’ with multiple myeloma, acute leukemias, lymphoproliferative disorders, myelofibrosis, marrow hypoplasia, osteitis fibrosa cystica and metastasis. BMB and BMA could detect tuberculous granulomas in 85.17% and 57.14% cases, respectively. However, parasitic infections (kala-azar, malaria) could be diagnosed exclusively in BMA. Conclusions: BMA and BMB are important, useful complementary diagnostic tools giving a higher diagnostic yield when used in conjunction.