Bone marrow biopsy in the metastatic work-up of solid tumors in children

The bone marrow biopsy has an established role in the evaluation of nonhematologic malignancies in adults. The results of the trephine bone marrow biopsy (BMB) and bone marrow aspiration (BMA) in 42 children with solid tumors were reviewed. Bone marrow biopsies were done for the following indications: (1) "dry tap," (2) equivocal presence of tumor in the BMA, (3) definitely no tumor in the BMA, (4) protocol requirements. Of the 42 children, 19 (45%) had metastases in the BMB; 9 (21%) had a positive BMA and BMB, and 10 (23%) had a positive BMB and a questionable or negative BMA. Patients were divided into two groups, according to the presence or absence of metastases in the biopsy. Their clinical, hematologic, and pathologic findings were reviewed. Comparison was made between patients with and those without metastases. No single hematologic parameter was predictive of bone marrow metastases. Nevertheless, percentages of hemoglobin and platelet counts were lower in patients with metastases. This study indicates that, in children as in adults, aspiration and biopsy are complimentary procedures in the workup for metastases in patients with solid tumors.