https://orcid.org/0000-0003-0886-7699
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ABSTRACT
Background
Trephine bone marrow biopsy (BMB) in internal medicine has only been studied in fever of unknown origin and inflammation of unknown origin. The aim was to assess BMB diagnostic yield according to main indications and patient characteristics in internal medicine. Quality of BMB and contribution of bone marrow aspiration (BMA) to BMB were also analyzed.
Methods
BMB performed in the internal medicine department of Poitiers university hospital between January 2000 and December 2015 were retrospectively analyzed. Patient characteristics, BMB indications, quality parameters, and results were collected from medical records. Contributive BMB was BMB allowing accurate final diagnosis. Diagnostic yield was the proportion of contributive BMB among total BMB performed.
Results
A total of 468 BMBs conducted for primary diagnostic purpose from 468 patients were analyzed. Cytopenia(s) and the indication ‘adenopathy and/or splenomegaly and/or hepatomegaly’ represented 70% of the indications. Overall BMB diagnostic yield was 32.7%, lymphoma being the main histologic finding (31%). Among indications, cytopenia(s) had the highest diagnostic yield (49.1%). Isolated fever of unknown origin had low diagnostic yield (5.6%). Factors independently associated with contributive BMB were: anemia, neutropenia, circulating immature granulocytes or blasts, monoclonal gammopathy, period of BMB processing, quality of BMB, and immunohistochemestry (IHC) analysis. Concomitant BMA improved diagnostic yield by 5.5%, mostly for myelodysplastic syndromes.
Conclusion
Cytopenia(s), blood cythemias and monoclonal gammopathy are indications with the highest diagnostic yield. Concomitant BMA and IHC analysis should be systematically performed to increase BMB diagnostic yield in internal medicine.
Acknowledgments
The authors acknowledge Jeffrey Arsham for his proofreading.
Supplementary Material
Supplemental data for this article can be accessed here.
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
Author contributions
Jean-Philippe Martellosio: Conceptualization, Writing - Original Draft, Formal analysis
Mathieu Puyade: Conceptualization, Formal analysis, Writing - Review and Editing
Celine Debiais: Writing - Review and Editing, Resources
Antoine Elsendoorn: Writing - Review and Editing, Resources
Odile Souchaud-Debouverie: Writing - Review and Editing, Resources
Cedric Landron: Writing - Review and Editing, Resources
Luminita Luca: Writing - Review and Editing, Resources
Frederique Roy-Peaud: Writing - Review and Editing, Resources
Serge Milin: Writing - Review and Editing, Resources
Pascal Roblot: Writing - Review and Editing, Resources
Mickael Martin: Conceptualization, Writing - Review and Editing, Supervision
Declaration of financial
The contents of the paper and the opinions expressed within are those of the authors, and it was the decision of the authors to submit the manuscript for publication.
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Ethical approval
This study was approved by local ethics committee and CNIL (Commission Nationale de l’Informatique et des Libertés) and registered under the number CHU86-R2018-12-02.
Patient consent for publication
Because this was a retrospective study conducted on already available data, obtaining patients formal consent was not required by local ethics committee and CNIL.