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The bone marrow examination in breast cancer: diagnostic considerations and clinical usefulness.

Bone marrow examinations were performed on 116 women with primary and metastatic breast cancer and were correlated with the clinical status of the patient and other specific diagnostic modalities. The relative diagnostic efficacy of the marrow biopsy, aspirate smear and clot section was examined, as was the value of serial marrow examinations. A marrow positive for tumor was found in 40% of those with metastatic disease, 55% with positive x-rays, 56% with positive bone scans, but only 4% (1/24) with both scan and x-ray normal. Routine hematologic parameters were of limited usefulness in predicting the finding of a positive marrow. The biopsy was superior to the smear and clot section but aspirated material also had to be analyzed to maximize diagnostic yield. When analyzed qualitatively, i.e., positive or negative for tumor, serial marrow examinations were not useful in assessing the efficacy of antitumor treatment. The potential usefulness of bone marrow examination in patients with breast cancer is discussed.

Biopsy, Needle

Bone marrow examination as a diagnostic tool in carcinoma of the prostate.

155 patients with a newly discovered carcinoma of the prostate were investigated for the presence of bone metastases. Straight X-ray (conventional X-ray) revealed such secondary in 38 cases and bone marrow examination in 20. Three patients with a normal X-ray picture nevertheless showed cancer cells on bone marrow examination. The authors consider bone marrow examination as a valuable complement to the routine invedtigation of the patients with carcinoma of the prostate.

Adenocarcinoma

Bone-marrow examination in the staging of small-cell anaplastic carcinoma of the lung with special reference to subtyping. An evaluation of 203 consecutive patients.

Histologic examination of bone-marrow from the posterior iliac crest was routinely done as a pretreatment staging procedure in 203 consecutive patients with small-cell anaplastic carcinoma of the lung. Subtyping of the patients according to the WHO classification included 27.8% with "fusiform" cell type (WHO II,1), 28.3% with "polygonal" cell type (WHO II,2), 42.8% with "lymphocyte-like" cell type (WHO II,3), and 1.1% with mixed types (WHO II,4). Bone-marrow involvement was found in 17.2%. No significant difference was observed among the histological subtypes with regard to bone-marrow involvement. A comparison of bone-marrow biopsy and aspiration in patients investigated with both procedures showed that aspiration alone was diagnostic in nine of 24 (38%) positive patients as compared with two of 24 (8%) with biopsy alone, while in the remaining 13 patients (54%) both procedures were positive. Of the 35 patients with positive bone-marrow examination, 77% had no other evidence of distant metastatic disease if liver metastases identified by peritoneoscopy and liver biopsy are excluded as a staging procedure. With the exception of thrombocytopenia which was observed in six patients, with bone-marrow metastases, hematological findings were of little value in detecting bone-marrow involvement.

Adult

Bilateral bone-marrow examinations in small-cell anaplastic carcinoma of the lung.

Bilateral bone-marrow examinations from the posterior iliac crests were routinely performed as a pretreatment staging procedure in 89 consecutive patients with small-cell anaplastic carcinoma of the lung. Bone-marrow involvement was found in 20 patients (22.5%), in 9 (10.1%) only on one side, and in 11 (12.4%) on both sides. Aspiration was found to be significantly superior to biopsy, being positive in 25 examinations as compared with 14 positive biopsies. Compared with unilateral bone-marrow examination the positive findings increased by approximately 30%. Bilateral bone-marrow examinations are recommended in patients in whom the detection of bone-marrow metastases will have therapeutic implications.

Biopsy, Needle

Bone marrow examination: for metastatic tumor: aspirate and biopsy.

A 6-year experience with bone marrow aspirates and biopsies (96 cases) positive for metastatic carcinoma is reviewed. Marrow examination detected secondary carcinoma in 58 cases (60%) despite negative roentgenographic and/or bone scan examinations. Breast carcinoma was the most frequent primary site. The bone marrow biopsy was superior to the aspirate in finding carcinoma (97% vs. 72%). However, in an occasional case, tumor was found only in aspirate preparations. Both procedures should be considered complementary and are recommended in the marrow evaluation of patients with carcinoma.

Biopsy, Needle

Bone marrow metastases without cortical bone involvement in breast cancer patients.

Bone marrow involvement by breast carcinoma in the absence of demonstrable bone lesions is unusual. We report six patients with medullary tumor without demonstration of cortical bone abnormality on scan or radiographs. This represents 2.8% of 213 patients with breast cancer in which bone marrow examination was performed and 6.2% of those in which marrow involvement was demonstrated.

Adenocarcinoma

Selection of patients for bone marrow transplantation in severe aplastic anemia.

Despite androgens and intensive supportive care, satisfactory survival in severe aplastic anemia remains at 20% or less. Histocompatible bone marrow transplantation can restore normal hematopoiesis in approximately 40% of similarly severe individuals. Delay of transplantation for 3 wk after diagnosis allows time for proper evaluation and for many spontaneous recoveries. Further delay increases risks of fatal complications and decreases chances for successful transplantation while the incidence of spontaneous remission declines. When available, early histocompatible bone marrow transplantation may be the treatment of choice for severe aplastic anemia.

Adolescent