Audit of bone marrow aspirates and trephine biopsies in multiple myeloma - a single centre study

We compared 79 simultaneous marrow aspirates and trephine biopsies, from multiple myeloma patients for sensitivity. concordance. quality and clinical relevance. A total of 60 examinations had been performed for initial diagnosis. i.e. in cases of suspected myeloma and 19 at follow-up. Of which. 45 (57%) of trephine biopsies were less than 1.6 cm before processing and 33 (42%) were crushed and/or fragmented. Overall. only 19/79 (24%) of trephine biopsy specimens were of at least 1.6 cut length prior to processing and not disrupted. On the other hand. 75% of aspirates were particulate and satisfactory. Mean time between receipt of a trephine biopsy specimen and issuance of a histopathological report was 9 days. Although 40% of trephine biopsies yielded information that could not bee reliably obtained from a bone marrow aspirate such information was in all cases clinically irrelevant or obtainable by non-invasive means. In all cases where myeloma was detected in a trephine biopsy it was also detected in a simultaneous bone marrow aspirate. if particulate. However. there were four (5%) cases in which myeloma was detected in such aspirates but not in simultaneously taken trephine biopsies. In cases (n = 19) where repeat aspirates/trephine biopsies were taken for surveillance. concordance was found between reported changes in plasma cell ratio. Our data failed to demonstrate any added benefit from routinely performing trephine biopsies after a particulate specimen had been aspirated for the diagnosis or surveillance of myeloma. Furthermore, they suggest that particulate aspirates may be at least as sensitive as trephine biopsies for detecting myeloma.