The Bone Marrow Biopsy

Abstract

Abstract The bone marrow core biopsy has emerged as an integral part of the evaluation of the hematologic patient (McFarland and Dameshek, 1958, Ellis et al, 1964). Bone marrow core biopsy is informative of details of marrow architecture and cellularity that are lost in the marrow aspirate smear. Bone marrow core biopsy is of particular value in the recognition of tumors and infiltrative processes involving the marrow, and is an indispensable tool for the staging of lymphomas and other malignant tumors with a significant incidence of marrow involvement. The Jamshidi-Swain bone marrow biopsy needle, introduced in 1971, represented a significant improvement over the previously utilized Vim-Silverman and Westerman-Jensen biopsy needles (Jamshidi and Swain, 1971). The ease of use and high quality of specimen obtained with the Jamshidi needle has contributed to the widespread acceptance of marrow biopsy as part of routine evaluation of the hematologic patient and routine staging of the cancer patient. The relative merits of bone marrow aspiration and bone marrow core biopsy are complementary. Bone marrow aspiration provides excellent cytologic detail; however, marrow architecture is lost. Bone marrow core biopsy provides (arguably in the case of plastic embedding) less cytologic detail, but architecture is preserved. In general, bone marrow biopsy is most useful when tumor or infiltrative disease of the marrow is suspected, whereas bone marrow aspiration is most useful for detailed cytologic evaluation of hematopoiesis. Complete hematologic evaluation therefore should include both bone marrow aspiration and marrow core biopsy. Routine tumor staging can usually be accomplished by marrow core biopsy alone.