Evaluation of sensitivity and specificity of bone marrow trephine biopsy tests in an Indian teaching hospital

Peer review under responsibility of Alexandria University Faculty of Medicine.

Available online 5 May 2017

Figures & data

Table 1 Cases diagnosed in BMA and BMB.

Diagnosis	Diagnosis done (Positive)	Diagnosis Missed (Negative)	Total	P value with chi^2 test
BM Aspiration	416	88	504	0.0001
BM Biopsy	494	10	504

The chi-square statistic is 68.7673. The p-value is 0.0001. This result is significant at p < 0.05.

Fig. 1 Pie chart showing age distribution.

Fig. 2 BMA showing hypocellular marrow, H&E (10 × 10).

Fig. 3 BMB confirming aplastic anemia H&E (10 × 10).

Fig. 4 (a) BMB showing hypocellularity & Fibrosis, H&E (10 × 10), (b) 40 × 10, yellow arrow-bizarre megakaryocytes, blue arrow-fibrosis, (c) 10 × 10 increased reticulin fibrosis of myelofibrosis.

Fig. 5 (a) 10 × 10 small cell lymphoma involving marrow, (b) 40 × 10 I.H.C.-lymphoma involving marrow, CD20 +ve.

Table 2 Number of entities in bone marrow aspiration and bone marrow biopsy.

SL No.	Entity	BM Aspiration		Total	% of cases diagnosed in BMA	BM Biopsy		Total	% of cases diagnosed in BMB
		Positive	Negative			Positive	Negative
1	Acute Leukemia	110	18	128	21.83	128	0	128	25.40
2	Aplastic Anemia	39	6	45	7.74	44	1	45	8.73
3	Myelo proliferative neoplasm	48	4	52	9.52	52	0	52	10.32
4	Lymphoma*	0	41	41	0.00	41	0	41	8.13
5	Chronic Lympho cytic leukemia	16	0	16	3.17	16	0	16	3.17
6	Multiple myeloma	41	1	42	8.13	42	0	42	8.33
7	Metastasis	4	2	6	0.79	6	0	6	1.19
8	Granuloma	2	2	4	0.40	4	0	4	0.79
9	Myelo dysplastic syndrome	20	5	25	3.97	25	0	25	4.96
10	Immuno thrombocytopenic purpura	32	0	32	6.35	32	0	32	6.35
11	Pure red cell aplasia	5	0	5	0.99	5	0	5	0.99
12	Reactive marrow	30	0	30	5.95	30	0	30	5.95
13	Elytroid hyperplasia	56	0	56	11.11	56	0	56	11.11
14	Necrosis	1	0	1	0.20	1	0	1	0.20
15	Hypersplinism	11	0	11	2.18	11	0	11	2.18
16	Haemophagocytic lympho histocytic syndrom	1	0	1	0.20	1	0	1	0.20
17	Normal bone marrow	0	9	9	0.00	0	9	9	0.00
18	Total	416	88	504	82.54	494	10	504	98.02

Note: Positive-Diagnosis done; Negative-Diagnosis missed; *Lymphoma including CLL/SLL is total 57 (41+16).

Table 3 Statistical probability of BMA and BMB tests.

Statistical probability	No. of cases
True Negative (TN)	9
True Positive (TP)	416
False Negative (FN)	78
False Positive (FP)	1

Table 4 Computed probability value of different statistics tests.

Test statistics	Formula	Value
Sensitivity	TP/(TP + FN)	0.84
Specificity	TN/(FP + TN)	0.90
Prevalence	(TP + FN)/N	0.98
Diagnostic accuracy	(TP + TN)/N	0.84
Positive predictivity	TP/(TP + FP)	0.99
Negative predictivity	TN/(FN + TN)	0.103
False positive rate	FP/(FP + TN)	0.1
False negative rate	FN/(TP + FN)	157
Positive likelihood ratio	Sensitivity/(1 − specificity)	8.4
Negative likelihood ratio	(1 − sensitivity)/specificity	0.177