Value of bilateral iliac crest needle biopsy for pretherapeutic tumor staging of bronchogenic carcinomas

A pathologist's perspective on bone marrow aspiration and biopsy: I. Performing a bone marrow examination

The bone marrow aspirate and biopsy is an important medical procedure for the diagnosis of hematologic malignancies and other diseases, and for the follow-up evaluation of patients undergoing chemotherapy, bone marrow transplantation, and other forms of medical therapy. During the procedure, liquid bone marrow is aspirated from the posterior iliac crest or sternum with a special needle, smeared on glass microscope slides by one of several techniques, and stained by the Wright-Giemsa or other techniques for micro-scopic examination. The bone marrow core biopsy is obtained from the posterior iliac crest with a Jamshidi or similar needle and processed in the same manner as other surgical specimens. Flow cytometric examination, cytochemical stains, cytogenetic and molecular analysis, and other diagnostic procedures can be performed on bone marrow aspirate material, while sections prepared from the bone marrow biopsy can be stained by the immunoperoxidase or other techniques. The bone marrow procedure can be performed with a minimum of discomfort to the patient if adequate local anesthesia is utilized. Pain, bleeding, and infection are rare complications of the bone marrow procedure performed at the posterior iliac crest, while death from cardiac tamponade has rarely occurred from the sternal bone marrow aspiration. The recent development of bone marrow biopsy needles with specially sharpened cutting edges and core-securing devices has reduced the discomfort of the procedure and improved the quality of the specimens obtained.

Bone marrow examination in small cell lung cancer--when is it indicated?

To assess the usefulness of bone marrow (BM) examination performed as part of the staging procedure in SCLC, 137 patients with this neoplasm were studied. At diagnosis, BM was infiltrated in 23 patients (17%) and in 5 of them (22%) it was the only metastatic site. BM examination changed the previously given stage in 9% of the patients who were supposed to have limited disease before this test was performed. BM involvement correlated with a higher frequency of bone (p less than 0.05) and liver (p less than 0.01) metastasis. Correlations were found neither with blood or serum biochemistry disturbances nor with postchemotherapy haematologic toxicity. The BM positive patients had a survival rate similar to those with extensive disease but without BM infiltration. We conclude that BM examination should be performed only when no other metastatic sites have been found after a complete staging study.