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An Evidence-based Recommendation for a Standardized Approach to Detecting Metastatic Neuroblastoma in Staging Bone Marrow Biopsies. Pediatr Dev Pathol 2017;20(1):38-43

Date

03/10/2017

Pubmed ID

28276294

DOI

10.1177/1093526616686253

Scopus ID

2-s2.0-85027123831 (requires institutional sign-in at Scopus site)   3 Citations

Abstract

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 institutional review board approval, 160 BM biopsies from 50 neuroblastoma patients were retrospectively selected. Hematoxylin and eosin-stained CB 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). Of the 160 BMs, 72 were positive for tumor in any component. Of these, 33 (45.8%) were positive in a single portion of the specimen: 19 CBs and 14 aspirates. Compared with overall diagnosis, sensitivities were as follows: CB 76.3%; aspirate 67.1%; core/aspirate combined 94.7%. Diagnostic CBs had significantly longer trabecular length than nondiagnostic CBs (6.74 mm vs 4.03 mm, P = .006). Positive CBs had longer trabecular space than negative marrows (7.91 mm vs 6.25 mm, P = .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 the optimal evaluation of BM for metastatic neuroblastoma.

Author List

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

Authors

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
Pippa M. Simpson PhD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin
Ke Yan PhD Associate Professor in the Pediatrics department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Biopsy, Large-Core Needle
Bone Marrow
Bone Neoplasms
Child
Child, Preschool
Evidence-Based Medicine
Female
Humans
Infant
Infant, Newborn
Male
Neoplasm Staging
Neuroblastoma
Practice Guidelines as Topic
Retrospective Studies
Sensitivity and Specificity