Bain B J
Department of Haematology, St Mary's Hospital Campus of Imperial College School of Medicine, Praed Street, London, W2 1NY, UK.
J Clin Pathol. 2001 Oct;54(10):737-42. doi: 10.1136/jcp.54.10.737.
Trephine biopsies of the bone marrow should be carried out, when clinically indicated, by trained individuals following a standard operating procedure. A bone marrow aspiration should be performed as part of the same procedure. For patient safety and convenience, biopsies are usually performed on the posterior iliac crest. The biopsy specimen should measure at least 1.6 cm and, if it does not, consideration should be given to repeating the procedure, possibly on the contralateral iliac crest. If bone marrow aspiration is found to be impossible, imprints from the biopsy specimen should be obtained. Otherwise, the specimen is placed immediately into fixative and after fixation is embedded in a resin or, more usually, decalcified and embedded in paraffin wax. Thin sections are cut and are stained, as a minimum, with haematoxylin and eosin and with a reticulin stain. A Giemsa stain is also desirable. A Perls' stain does not often give useful information and is not essential in every patient. The need for other histochemical or immunohistochemical stains is determined by the clinical circumstances and the preliminary findings. Trephine biopsy sections should be examined and reported in a systematic manner, assessment being made of the bones, the vessels and stroma, and the haemopoietic and any lymphoid or other tissue. Assessment should begin with a very low power objective, the entire section being examined. Further examination is then done with an intermediate and high power objective. Ideally, reporting of trephine biopsy sections should be done by an individual who is competent in both histopathology and haematology, and who is able to make an appropriate assessment of both the bone marrow aspirate and the trephine biopsy sections. When this is not possible, there should be close consultation between a haematologist and a histopathologist. The report should both describe the histological findings and give an interpretation of their importance. A signed or computer authorised report should be issued in a timely manner. If the report is a preliminary, this must be clearly stated.
如有临床指征，应按标准操作程序由经过培训的人员进行骨髓环钻活检。骨髓穿刺应作为同一操作的一部分进行。为了患者安全和方便，活检通常在髂后上棘进行。活检标本长度应至少为1.6 cm，若未达到该长度，应考虑重复操作，可能在对侧髂后上棘进行。若发现无法进行骨髓穿刺，应从活检标本获取印片。否则，标本应立即放入固定剂中，固定后包埋于树脂中，或更常见的是经脱钙后包埋于石蜡中。切取薄片，至少用苏木精和伊红染色以及网状纤维染色。吉姆萨染色也很有必要。普鲁士蓝染色通常无法提供有用信息，并非每位患者都必需。其他组织化学或免疫组织化学染色的需求由临床情况和初步检查结果决定。骨髓环钻活检切片应系统检查并报告，评估内容包括骨、血管和间质以及造血组织和任何淋巴组织或其他组织。评估应从使用极低倍物镜开始，检查整个切片。然后用中倍和高倍物镜进一步检查。理想情况下，骨髓环钻活检切片的报告应由具备组织病理学和血液学能力、能够对骨髓穿刺液和骨髓环钻活检切片进行适当评估的人员完成。若无法做到这一点，血液科医生和组织病理科医生之间应密切协商。报告应既描述组织学检查结果，又对其重要性作出解释。应及时出具签名或计算机授权的报告。若报告为初步报告，必须明确说明。
