Evaluation of bone marrow in 143 lymphomas: the relative frequency and pattern of involvement, secondary myelopathies, pitfalls and diagnostic validity.

UNLABELLED: The aim of the present study is to assess the frequency of bone marrow (BM) involvement by both bone marrow aspirate and biopsy (BMA and BMB, respectively) procedures in established cases of lymphomas at initial presentation, and to study the relative frequency of marrow disease in relation to lymphoma types, patterns of infiltration and the 2ry associated changes, as well as the diagnostic challenges. Moreover, the diagnostic validity of BMA is tested taking the results of the BMB as the true test results, in order to determine the role of each procedure in the diagnostic approach of marrow infiltration. PATIENTS AND METHOD: This is a retrospective study carried out on 143 nonconsecutive Egyptian patients with lymphomas obtained from a private series during the years 2005 to 2008. Criteria of inclusion included the availability of full medical records and material (medical and pathological), patient consent, nodal disease with no therapy prior to BM sampling, except in 7 patients who had another 2nd BMB following therapy. BMA and BMB were performed as part of the routine workup for diagnosis and staging of lymphoma. The patients had a male to female sex ratio of 2.6:1 and a wide age range from 4 to 74 years. RESULTS: In the present series, 64 cases out of the 143 lymphoma patients studied (44.8%) had a BM disease. Involvement was mostly bilateral (80%). Patients older than 40 years showed higher incidence of bone marrow involvement. There was complete concordance (100%) between both diagnostic procedures in the detection of 76 marrow disease-free lymphoma patients. BMA showed no false positive results and a low rate of deference that makes of it an ideal screening test. Three deferred smears of CLL for BMB diagnosis were all positive for involvement. However, in a total number of 64 BMB positive patients, aspirates could only identify lymphoma involvement in 42 lymphoma patients and missed 22 patients with a BM disease, with an overall sensitivity rate of 65.6%. BMB had a high diagnostic viability and is an easily applied reproducible procedure for diagnosis of BM involvement based on a more detailed informative analysis of both architectural and individual cytomorphologic changes. CONCLUSION: The relatively high level of BM involvement in Egyptian lymphoma patients was directly proportional to high-risk factors. The diagnostic validity of BMB is higher than that of BMA. However, BMA serves as a good positive test in screening lymphomas for marrow disease. A negative BMA does not exclude involvement. Thus, smears should be taken as a complimentary procedure.

Intra-operative diagnosis of breast mass-lesions: comparison of the validity of touch smear preparation and frozen section techniques.

BACKGROUND: A reliable intra-operative pathological diagnosis is a mandatory before proper surgery of breast cancer. So far, The Frozen Section Technique (FS) is the standard technique with a relatively high level of validity. However, when the special facilities of FS are unavailable, Touch Smears Preparation technique (TSP) could be alternatively adopted. OBJECTIVE: Our objective is to compare the validity of TSP in the intraoperative diagnosis of breast mass lesions, with that of FS technique. An additional aim is to determine the special advantages of both techniques. PATIENTS AND METHODS: The study was conducted on 130 breast mass lesions, obtained from operable cases, requesting intra-operative diagnosis at the Pathology Department at the National Cancer Institute (NCI), Cairo University, during the years 2004-2007. The specimens were subjected to the two diagnostic techniques, namely: FS and TSP. Then both were examined separately, by two different observers. The results were expressed as: positive for malignancy, negative for malignancy or deferred diagnosis. The validity of each FS and TSP is tested by using the validity statistical formulas and then results of both were compared. Paraffin section was the golden standard for the true diagnosis. RESULTS: The accuracy of FS was found to be higher than TSP (100%). Thus, a sensitivity of 100% and a specificity of 100%. Whereas, TSP had a sensitivity of 92.99%, a specificity of 93.33% and an overall accuracy of 92.5%. TSP had also a negative predictive value of 80% and the positive predictive value was 97.65%. The rate of deferred diagnosis was lower in FS (1.5%) than TSP (6.2%). CONCLUSIONS: The study concluded that The FS is much superior to TSP in intra-operative the diagnosis of breast mass. However, when the special FS equipment is lacking, TSP could be a reliable alternative provided that an experienced cytopathologist is available. Analysis of predictive value rates revealed that a positive cytological report is more reliable than a negative one. Moreover, TSP could also be an adjuvant to FS.