Utility of bone marrow and liver biopsies for staging cutaneous T-cell lymphoma

The wide use of staging procedures, looking for visceral involvement in patients with cutaneous T-cell lymphoma (CTCL), is controversial, especially in the early stages. In this study, we analyzed the results of bone marrow biopsy and laparoscopy with liver biopsy in a series of 43 patients with CTCL.

Clinicopathologic stages were established by a modification of the TNM system proposed in 1979. Results of staging procedures were correlated with blood cell counts and laboratory tests. The usefulness of the staging procedures was analyzed particularly in patients without clinical or biologic evidence of extracutaneous disease.

The patient's median age was 66 years; 35 patients were men and eight women. The clinicopathologic stages were as follows: T1: 3 cases; T2: 15; T3: 14; T4: 11; N0: 15; N1: 28; M0: 38; M1: 5; B0: 37; and B1: 6 cases. Internal lymph node disease, diagnosed by lymphangiography and/or abdominal scanning, was demonstrated in 37% of patients. Bone marrow infiltration was seen in 12% of patients and was the only form of visceral involvement. All liver biopsies were negative. Serum lactate dehydrogenase (LDH) levels were raised in patients with lymph node disease; it was the only laboratory test that correlated with extracutaneous involvement. Staging procedures changed three of the nine patients with a clinical T1-T2N0M0B0 stage (33%) to a more advanced stage. The abdominal lymph node evaluation allowed a reclassification from N0 to N1 in two of nine cases (22%); one of the remaining cases was reclassified from M0 to M1 on the basis of bone marrow biopsy results.

Our results indicate that bone marrow biopsy is a useful investigational procedure for determining extracutaneous disease in CTCL. Peritoneoscopy with liver biopsy rarely is informative; however, as our study does not include a very large number of patients, these preliminary conclusions must be confirmed in the future by including more cases.