Indications for and Value of Bone Marrow Trephine Biopsy in Haematological Disorders
1a Division of Hematology/Oncology, Department of Medicine , Buffalo General Hospital , Buffalo , New York.
The bone marrow in haematological disorders has traditionally been investigated in small samples of marrow obtained by aspiration Although the value of solid tissue preparations in the diagnosis of bone marrow disorders has long been recognised (1,2), it is only recently that the technique has gainec acceptance among haematologist and oncologists (3). This is specifically due to the development of new needles (4,5) that ensure an effective, atraumatic procedure and also impose little or no damage upon the biopsied tissue. Further, the technique of processing bone marrow trephine biopsies (BMTB) in plastic (methyl- and glycol-methacrylate) (6,7) eliminates the requirement for decalcification (and its attendant abuse of the specimen) while providing thin 1-2 μm sections (as opposed to the standard 5-8 μm paraffin sections) that are stainable with Romanowsky stains (eg. Giemsa, May-Grunwald & Giemsa)instead of the routinely utilised, less specific H & E stain. The introduction of enzyme and immunohistological techniques on plastic(glycolmethacrylate) embedded bone marrow biopsies has improved the diagnostic evaluation of bone marrow (7,8,9). The ability to perform molecular studies on BMTB specimens has now added a new dimension in the diagnostic evaluation of bone marrow in haematological disorders such as the leukaemias, myelodysplastic syndromes and malignant lymphomas with bone marrow infiltration (10,11).
The bone marrow in haematological disorders has traditionally been investigated in small samples of marrow obtained by aspiration Although the value of solid tissue preparations in the diagnosis of bone marrow disorders has long been recognised (1,2), it is only recently that the technique has gainec acceptance among haematologist and oncologists (3). This is specifically due to the development of new needles (4,5) that ensure an effective, atraumatic procedure and also impose little or no damage upon the biopsied tissue. Further, the technique of processing bone marrow trephine biopsies (BMTB) in plastic (methyl- and glycol-methacrylate) (6,7) eliminates the requirement for decalcification (and its attendant abuse of the specimen) while providing thin 1-2 μm sections (as opposed to the standard 5-8 μm paraffin sections) that are stainable with Romanowsky stains (eg. Giemsa, May-Grunwald & Giemsa)instead of the routinely utilised, less specific H & E stain. The introduction of enzyme and immunohistological techniques on plastic(glycolmethacrylate) embedded bone marrow biopsies has improved the diagnostic evaluation of bone marrow (7,8,9). The ability to perform molecular studies on BMTB specimens has now added a new dimension in the diagnostic evaluation of bone marrow in haematological disorders such as the leukaemias, myelodysplastic syndromes and malignant lymphomas with bone marrow infiltration (10,11).
