Diagnostic Utility of Bone Marrow Biopsy in Haematological Malignancies: A Seven Year Retrospective Study from Nigeria
Ugwa, O.
Department of Anatomical Pathology, University of Port Harcourt Teaching Hospital, Rivers State, Nigeria.
Korubo, K.I. *
Department of Haematology and Blood Transfusion, Rivers State University Teaching Hospital, Rivers State, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Background: Bone marrow aspirate (BMA) and bone marrow biopsy (BMB) are complementary procedures in the evaluation of haematological disorders. While aspirate smears often suffice for diagnosis, trephine biopsy provides additional value in cases with focal lesions, inadequate aspirate yield, or marrow fibrosis.
Aim: This study aims to assess the diagnostic utility of the bone marrow biopsy in haematological malignancies and determine the concordance rate of aspirate and biopsy reports in diagnosing haematological malignancies.
Methods: This retrospective study observed 125 adult cases seen over seven years in which paired BMA and BMB were obtained from the same instance at a Nigerian tertiary center. Clinical indications, full blood count parameters, and final histological diagnoses were recorded. Diagnostic concordance between BMA and BMB was determined, and discordant cases were further characterized.
Results: Anaemia was the predominant indication for marrow evaluation, present in 90.4% of patients. The most frequently diagnosed haematological malignancies on bone marrow biopsy were multiple myeloma and acute myeloid leukaemia, while polycythaemia rubra vera and chronic eosinophilic leukaemia were rare. Overall, concordance between BMA and BMB was 84.8% (106/125), while discordance was 15.2% (19/125), with metastatic bone disease (80%) and myelofibrosis (38.5%) being the highest discordant diagnoses. The data were entered into Microsoft Excel and analyzed using IBM SPSS Statistics version 29 (IBM Corp., Armonk, N.Y., USA) while the concordance between the two diagnostic modalities was assessed using Cohen’s kappa statistic.
Conclusion: This study evaluated concurrent bone marrow aspiration and biopsy, demonstrating their diagnostic value. Biopsy proved superior in detecting focal lesions and in cases of "dry taps" in bone marrow aspirates. Combining both methods enhances diagnostic accuracy, with biopsy being crucial in specific cases.
Keywords: Bone marrow aspirate, bone marrow biopsy, cytopenias, diagnostic concordance, haematological malignancies