Comparison between aspirates (cytology and histology) and biopsy (cytology and histology) in bone marrow evaluation in simple peripheral cytopenia
Vigliani, R.
Pathologica 91(1): 6-12
1999
ISSN/ISBN: 0031-2983 PMID: 10396944 Document Number: 505225
In order to assess a "basic" comparison between needle biopsy (B) and aspirate (A) in terms of diagnostic efficacy two hundred consecutive samples of bone marrow from 180 patients with simple (non neoplastic) peripheral cytopenia were examined. Both B and A from the identical anatomical site (posterior superior iliac spine) were performed in every case. Histology (I) and cytology (C) were systematically prepared from B (IB and CB) and from A (IA and CA). The cases were subdivided in 7 groups according to the type of cytopenia (mono-bi-trilinear). From a nosologic point of view these corresponded to common hematological disorders. As far as myelodysplasia (MD) is concerned only refractory anemia (RA) and refractory anemia with ring sideroblasts (RARS) were included. MD represented 28.6% of anemias which in turn covered 63.0% of all the cases. The diagnostic significance of I and C referred to the final diagnosis (A + B). In each group were compared (vs) A (CA + IA) vs B (IB + CB), IB vs CA, CA vs IA,IB vs CB and IB vs IA. The results were expressed by putting each related case into one of the following three cathegories: equivalence, superiority, inferiority. Equivalence could be diagnostically significant or non significant. Combination I + C was diagnostic in 100% of cases for A + B and IB + CA, in 96.5% for CA + IA, in 92.5% for IB + CB. Combination IB + IA was significant in 99.5% of samples, similarly supported by IB and IA respectively accounting for 91.0% and 90.0 of diagnoses. Individually CA was diagnostic in 92.0% and CB in 80.5% of cases. In some istances uneffective CA was implemented by IA (4.5%) and analogously IB by CB (1.5%). Within A CA gave little more significance than IA (only +2.0%). The different rates of I + C coincident diagnostic significance were: 97.5% (A + B), 85.5% (CA + IA), 83.0% (IB + CA), 79.0% (IB + CB). In 25.0% of MD cases diagnosis was assured by A only. In case of diagnostic discrepancy the classical morphologic parameters as cellularity, linearity and cytological details were also comparatively analysed. 1) the data above mentioned measure the diagnostic efficacy of the various procedures, individually or in association, with reference to the examined area, but they can be "basically" significant in the perspective of other comparisons; 2) as a whole B and A showed diagnostic equivalence, but A was more contributory in RA and RARS; this methologically means that CA needs to be reappraised and that IA is very reliable; 3) association I + C seems to be the best procedural approach in order to provide complementary morphology and amplified availability of material for examination, diagnosis and further study; 4) the performance of histopathologist can be improved by simultaneous cytological evaluation.