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Annals of Oncology 14:273-276, 2003
© 2003 European Society for Medical Oncology

Original Paper

Optimum trephine length in the assessment of bone marrow involvement in patients with diffuse large cell lymphoma

J. K. Campbell1, J. P. Matthews2, J. F. Seymour3, M. M. Wolf4 and S. K. Juneja On behalf of the Australasian Leukaemia Lymphoma Group4,+

1 Division of Laboratory Services, Royal Children’s Hospital, Parkville; 2 Statistical Centre and 3 Department of Haematology and Medical Oncology, Peter MacCallum Cancer Institute, East Melbourne; 4 Department of Diagnostic Haematology, Royal Melbourne Hospital, Parkville, Victoria, Australia

Received 24 June 2002; accepted 17 July 2002

Background:

The National Cancer Institute has recommended a bone marrow biopsy length of >=20 mm for the staging and surveillance of patients with non-Hodgkin’s lymphoma. However, there are few published data to support this recommendation, particularly the role of examining multiple levels.

Patients and methods:

Bone marrow biopsies from 172 patients with newly diagnosed diffuse large cell lymphoma (DLCL) entered in two consecutive trials of the Australasian Leukaemia and Lymphoma Group were analysed. The original haematoxylin and eosin-stained trephine biopsy and two or more deeper sections cut at 0.1–0.2 mm intervals were assessed with respect to the morphology, extent and pattern of lymphomatous involvement. The rate of positive diagnosis was correlated with the length of the biopsy specimen and the number of sections examined.

Results:

Forty-seven biopsies (27%) demonstrated marrow involvement on examination of a mean of four trephine biopsy sections. The rate of positivity increased with the examination of multiple levels and correlated with increasing trephine length but was not dependent on the number of sites sampled. Twenty per cent of biopsies <20 mm in length were positive for lymphoma; this increased to 35% for biopsies >=20 mm (P = 0.023).

Conclusions:

Morphological bone marrow involvement in DLCL is optimally demonstrated by a 20-mm long trephine biopsy from a single site which is examined at multiple levels (four or more). This obviates the need for bilateral sampling, thereby reducing patient morbidity from the procedure. This study provides evidence to support the National Cancer Institute recommendations regarding trephine biopsy in the staging of DLCL, providing multiple levels are examined.

Key words: bone marrow involvement, bone marrow trephine, diffuse large cell lymphoma


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