Shubham Bhattacharya, Barnali Maiti, Sudipta Bhattacharyya, Arghya Bandyopadhyay
BACKGROUND Lymphoma involving bone marrow is considered as stage-IV irrespective of its primary presentation. The treatment and prognosis depend upon the stage of lymphoma. Bone marrow involvement can be confirmed by immunohistochemistry (IHC), cytogenetics and molecular analysis, and scanning. But, due to limited resources in developing countries like India, these procedures are not available in most of the institutions and laboratories, where morphological examination of bone marrow is the only way to diagnose bone marrow involvement in lymphoma. The purpose of the study is to compare the sensitivity and specificity of bone marrow aspiration, trephine biopsy, and imprint, to diagnose marrow involvement in lymphoma. METHODS The study was conducted on 51 lymphoma patients in BMCH for 18 months. In each case, bone marrow aspiration, trephine biopsy, and imprint, were taken. Bone marrow involvements were diagnosed, and confirmed, by trephine biopsy with IHC. Sensitivity and specificity of each of the procedures of morphological studies were calculated. RESULTS Bone marrow involvement was found in 14 cases (27.45%) with frequency in non-Hodgkin lymphoma being 32.5% and in Hodgkin lymphoma 9.09%. Small lymphocytic lymphoma involved the bone marrow most frequently (50%) followed by follicular lymphoma and diffuse large B cell lymphoma. Biopsy was most sensitive method, and imprint was most specific. CONCLUSIONS Trephine biopsy along with imprint smear should be the procedure of choice with IHC as an adjunctive procedure.
