Service de Médecine Interne, Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Poitiers , Poitiers, France.
Service d'Anatomie et Cytologies Pathologiques, Centre Hospitalier Universitaire de Poitiers , Poitiers, France.
Postgrad Med. 2021 Jan;133(1):89-95. doi: 10.1080/00325481.2020.1835118. Epub 2020 Nov 4.
Trephine bone marrow biopsy (BMB) in internal medicine has only been studied in fever of unknown origin and inflammation of unknown origin. The aim was to assess BMB diagnostic yield according to main indications and patient characteristics in internal medicine. Quality of BMB and contribution of bone marrow aspiration (BMA) to BMB were also analyzed.
BMB performed in the internal medicine department of Poitiers university hospital between January 2000 and December 2015 were retrospectively analyzed. Patient characteristics, BMB indications, quality parameters, and results were collected from medical records. Contributive BMB was BMB allowing accurate final diagnosis. Diagnostic yield was the proportion of contributive BMB among total BMB performed.
A total of 468 BMBs conducted for primary diagnostic purpose from 468 patients were analyzed. Cytopenia(s) and the indication 'adenopathy and/or splenomegaly and/or hepatomegaly' represented 70% of the indications. Overall BMB diagnostic yield was 32.7%, lymphoma being the main histologic finding (31%). Among indications, cytopenia(s) had the highest diagnostic yield (49.1%). Isolated fever of unknown origin had low diagnostic yield (5.6%). Factors independently associated with contributive BMB were: anemia, neutropenia, circulating immature granulocytes or blasts, monoclonal gammopathy, period of BMB processing, quality of BMB, and immunohistochemestry (IHC) analysis. Concomitant BMA improved diagnostic yield by 5.5%, mostly for myelodysplastic syndromes.
Cytopenia(s), blood cythemias and monoclonal gammopathy are indications with the highest diagnostic yield. Concomitant BMA and IHC analysis should be systematically performed to increase BMB diagnostic yield in internal medicine.
内科领域的环钻式骨髓活检（BMB）仅在不明原因发热和不明原因炎症中进行了研究。本研究旨在评估内科患者中根据主要适应证和患者特征进行 BMB 的诊断收益，并分析 BMB 的质量和骨髓抽吸（BMA）对 BMB 的贡献。
回顾性分析了 2000 年 1 月至 2015 年 12 月在普瓦捷大学医院内科进行的 BMB。从病历中收集了患者特征、BMB 适应证、质量参数和结果。有贡献的 BMB 是指能够准确诊断的 BMB。诊断收益是指进行的所有 BMB 中具有诊断价值的 BMB 的比例。
共分析了 468 例因原发性诊断目的进行的 468 次 BMB。细胞减少症和“淋巴结病和/或脾肿大和/或肝肿大”是最常见的适应证，占 70%。总体而言，BMB 的诊断收益为 32.7%，淋巴瘤是主要的组织学发现（31%）。在各种适应证中，细胞减少症的诊断收益最高（49.1%）。孤立性不明原因发热的诊断收益较低（5.6%）。与有贡献的 BMB 独立相关的因素有：贫血、中性粒细胞减少症、循环不成熟粒细胞或原始细胞、单克隆丙种球蛋白病、BMB 处理时间、BMB 质量和免疫组织化学（IHC）分析。同时进行 BMA 可使诊断收益提高 5.5%，主要是为了诊断骨髓增生异常综合征。
细胞减少症、血细胞增多症和单克隆丙种球蛋白病是诊断收益最高的适应证。在内部医学中，应系统地进行同时 BMA 和 IHC 分析，以提高 BMB 的诊断收益。
