Ebie N, Loew J M, Gregory S A
Department of Medicine, Rush Presbyterian-St. Luke's Medical Center, Chicago, Illinois.
Hematol Pathol. 1989;3(1):29-33.
Several reports have suggested that bilateral bone marrow biopsy is better than unilateral biopsy in staging non-Hodgkin's lymphomas. Therefore since 1975, bilateral iliac crest bone marrow biopsy has been part of our standard initial staging investigation of non-Hodgkin's lymphomas. The present study is to determine the relative value of bilateral marrow biopsy compared to the unilateral procedure. We studied 176 patients who had evaluable adequate bilateral biopsies and tumor histology. Among 57 patients with low-grade lymphoma, 7 (12%) were unilaterally positive for lymphoma and 25 (44%) were bilaterally positive. Among 119 patients with intermediate and high-grade lymphoma, 6 biopsies (5%) were unilaterally positive and 10 (8%) were bilaterally positive for lymphoma. Doing the second (contralateral) biopsy changed the disease stage as assessed by bone marrow biopsy in 6.1% of patients with favorable histologies and in 2.5% of patients with unfavorable histologies. These changes are small. Moreover, treatment would not have been significantly altered in the majority of patients as a result of the changes. We conclude that the routine use of bilateral trephine biopsy in initial staging of non-Hodgkin's lymphomas needs to be reappraised. We believe that its use should be limited to selected patients in whom the finding of bone marrow involvement may influence the choice of treatment.
几份报告表明，在非霍奇金淋巴瘤分期方面，双侧骨髓活检比单侧活检更好。因此，自1975年以来，双侧髂嵴骨髓活检一直是我们对非霍奇金淋巴瘤进行标准初始分期检查的一部分。本研究旨在确定双侧骨髓活检相对于单侧活检的相对价值。我们研究了176例有可评估的充分双侧活检及肿瘤组织学检查结果的患者。在57例低度淋巴瘤患者中，7例（12%）单侧淋巴瘤阳性，25例（44%）双侧阳性。在119例中高度淋巴瘤患者中，6例活检（5%）单侧淋巴瘤阳性，10例（8%）双侧阳性。进行第二次（对侧）活检后，骨髓活检评估的疾病分期在6.1%组织学表现良好的患者和2.5%组织学表现不良的患者中发生了改变。这些改变很小。此外，大多数患者的治疗不会因这些改变而有显著变化。我们得出结论，在非霍奇金淋巴瘤初始分期中常规使用双侧环钻活检需要重新评估。我们认为，其应用应限于骨髓受累情况的发现可能影响治疗选择的特定患者。
