Scudla V, Adam Z
III interní klinika Lékarské fakulty UP a FN Olomouc.
Vnitr Lek. 2006 Nov;52 Suppl 2:55-65.
The aim of this study is to give a current view of the importance of evaluating preparations of smears of bone marrow (BM) aspirates in the diagnosing and monitoring the course of multiple myeloma (MM). Special attention is given to the indication and technique of aspiration biopsy, diagnostic and differential-diagnostic importance of evaluating the percentage representation of plasmatic cells in the bone marrow and their morphological deviation from the point of view of distinguishing them from reactive plasmocytosis and monoclonal gammopathy of undetermined significance. Also addressed is the issue of selected morphological classification systems including their benefits in identifying and forecasting the prognosis for the disease. A large part of the report is dedicated to the interpretational limitations of evaluating BM smear samples for the diagnosis and monitoring of the course of MM, and due attention is also given to indication for and assessment of the importance of histological examination of a BM trepanobioptic sample of bone marrow and the benefits of particular specialized methods, especially the examination of immunophenotypic, proliferative and apoptotic qualities of plasmocytes. The report shows that quantitative and cytomorphological evaluation of bone marrow samples still forms integral part of the standard algorithm of methods used in MM diagnosing and monitoring, and requires an extremely qualified approach to BM collection, the preparation of the smear and to precise evaluation, as well from the point of view of clinical interpretation.
本研究的目的是就评估骨髓穿刺涂片在诊断和监测多发性骨髓瘤（MM）病程中的重要性给出当前观点。特别关注穿刺活检的适应证和技术、评估骨髓中浆细胞的百分比及其形态学偏离的诊断和鉴别诊断重要性，从将它们与反应性浆细胞增多症和意义未明的单克隆丙种球蛋白病区分开来的角度来看。还讨论了选定的形态学分类系统问题，包括它们在识别和预测疾病预后方面的益处。报告的很大一部分致力于评估骨髓涂片样本用于MM诊断和病程监测的解释局限性，并且也适当关注了骨髓环钻活检样本组织学检查的适应证和重要性评估以及特定专业方法的益处，特别是浆细胞免疫表型、增殖和凋亡特性的检查。该报告表明，骨髓样本的定量和细胞形态学评估仍然是MM诊断和监测中使用的标准方法算法的组成部分，并且从临床解释的角度来看，需要对骨髓采集、涂片制备和精确评估采取极其专业的方法。
