Bone marrow biopsy in Hodgkin's lymphoma

Abstract

: In the study of patients with Hodgkin's lymphoma (HL) the evaluation of bone marrow biopsy (BMB) can be difficult. In this review we analyze the main diagnostic features and the clinical risk factors of BM involvement. Although the role of BMB is criticized by some authors, its value is irreplaceable in the staging of HL and in the diagnosis of primary medullary HL. The Ann Arbor staging committee criteria should be revised and updated in the light of the current immunohistochemical studies that give a fundamental help in the diagnostic process. A single BMB should be adequate for diagnosis in most instances. In cases of suspicious involvement a controlateral BMB could be performed.

Clinicopathological features of bone marrow infiltration in hodgkin lymphoma. should bone marrow staging be done only in high risk patients?

“…BM necrosis and fibrosis were seen in one case each. BM necrosis and fibrosis are findings often associated with BM infiltration of Hl and, when present, should raise the suspicion of BM involvement in a given case (1,7,12 (10). all these data suggest that doing BM staging only in high risk patients might not be sufficient.…”

“…This indicates the importance of adequate sampling while doing a BM staging in cases of Hl. Cases with focal involvement can be missed unless an adequate length of BM is sampled (1). BM necrosis and fibrosis were seen in one case each.…”

“…BM studies are a part of the staging workup for Hl as BM involvement is considered Stage iV disease (1,2). in spite of the advances like positron emission tomography, BM biopsy is still essential to confirm BM involvement in Hl (11).…”

“…Hence some authors have suggested that BM studies can be done in selected high risk cases alone (5,8,9). However, a controversy exists as few other authors suggest that BM should be done in all the adult cases (1,10). This study was done to detect the frequency and morphology of BM involvement in Hl, to study the association of BM involvement with various clinical and hematological parameters and to find whether BM involvement is restricted to certain high risk groups alone.…”

Clinical utility of 18F FDG-PET/CT in the detection of bone marrow disease in Hodgkin's lymphoma

“…Radiologically, CT may depict cortical bone changes but has low sensitivity for early bone marrow involvement [8,9]. Unilateral or bilateral BMB of the dorsal iliac crest is considered as the standard method for detecting bone marrow involvement complemented by MRI when needed [2,[10][11][12]. The potential role of FDG-positron emission tomography (PET)/CT is yet to be determined for the assessment of bone marrow involvement, as very few systematic studies have been carried out in this regard.…”