The Importance of Bone Marrow Biopsy in the Staging of Patients With Lymphosarcoma

The frequency of bone marrow involvement in patients with lymphosarcoma (LSA) and the particular value of the marrow biopsy, as compared with the aspiration smear technique, in the initial staging of this disease were investigated. Certain physical findings and laboratory studies were analyzed to determine whether the presence of marrow invasion could be predicted. Of 75 patients, 47 (63%) were found to have a positive marrow examination. The clinical stage of 40 of these 75 patients was changed to stage IV as a result of bone marrow biopsy; these included four of nine (44%) stage I patients, 9 of 12 (75%) stage 5 patients, and 27 of 41 (65%) stage III patients. Bone marrow biopsy more often yielded positive results (62%) than did aspiration smears (38%). Little correlation was found between extent of disease on initial physical examination and marrow involvement. A normal hematocrit, white blood cell count, and/or platelet count did not preclude the presence of marrow invasion. The technique of bone marrow biopsy is a simple and valuable procedure in the staging of lymphosarcoma. It uncovers unsuspected and widespread diseases in those patients whose illness appears restricted to even one or two node groups. The high frequency of marrow involvement in patients with LSA is evidence that many patients have widespread disease at the time of diagnosis; thus, marrow biopsy, when positive, is an invaluable test for their initial staging. We urge that it be performed routinely in all patients, irrespective of apparent clinical extent of disease.