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An evidence-based recommendation for a standardized approach to detecting metastatic neuroblastoma in staging bone marrow biopsies. Pediatr Dev Pathol 2016 Mar 28:



Pubmed ID





Neuroblastoma is a common malignant tumor of childhood. Accurate bone marrow (BM) evaluation for metastatic tumor is essential; however, no standardized pathologic workup exists for staging BMs. We examined the diagnostic yield of various BM components and optimal core biopsy (CB) length as part of developing evidence-based recommendations for BM evaluation. After obtaining IRB approval, 160 BM biopsies from 50 neuroblastoma patients were retrospectively selected. H&E-stained CB and clot sections and Wright-stained aspirates were scored as positive, negative, or indeterminate. Total/trabecular CB lengths were measured using cellSens software and a DP71 camera (Olympus). 76/160 BMs were positive for tumor in any component. Of these, 37 (48.7%) were positive in a single portion of the specimen: 19 CBs, 14 aspirates, and 4 clots. Compared with overall diagnosis, sensitivities were as follows: CB 76.3%; aspirate 67.1%; clot 66.7%; core/aspirate combined 94.7%. Mean total Diagnostic CBs had significantly longer trabecular length than nondiagnostic CBs (6.74 mm vs. 4.03 mm, p =0.006). Positive CBs had longer trabecular space than negative marrows (7.91 mm versus 6.25 mm, p= 0.002). Nearly 50% of our positive specimens showed diagnostic discordance among the various components examined. However, combining CB and aspirate examination improved sensitivity for tumor detection. We therefore recommend bilateral CBs (>1 cm each) and aspirates for optimal evaluation of BM for metastatic neuroblastoma.

Author List

Parsons LN, Gheorghe G, Yan K, Simpson P, Jarzembowski JA


Jason A. Jarzembowski MD, PhD Sr Associate Dean, CEO CSG, Professor in the Pathology department at Medical College of Wisconsin
Lauren Parsons MD Associate Professor in the Pathology department at Medical College of Wisconsin