UTILITY OF BONE-MARROW AND LIVER BIOPSIES FOR STAGING CUTANEOUS T-CELL LYMPHOMA

Background, The wide use of staging procedures, looking for visceral i nvolvement in patients with cutaneous T-cell lymphoma (CTCL), is contr oversial, especially in the early stages. In this study, we analyzed t he results of bone marrow biopsy and laparoscopy with liver biopsy in a series of 43 patients with CTCL. Methods. Clinicopathologic stages w ere established by a modification of the TNM system proposed in 1979. Results of staging procedures were correlated with blood cell counts a nd laboratory tests. The usefulness of the staging procedures was anal yzed particularly in patients without clinical or biologic evidence of extracutaneous disease. Results. The patient's median age was 66 year s; 35 patients were men and eight women. The clinicopathologic stages were as follows: T1: 3 cases; T2: 15; T3: 14; T4: 11; N0: 15; N1: 28; M0: 38; M1: 5; B0: 37; and B1: 6 cases. Internal lymph node disease, d iagnosed by lymphangiography and/or abdominal scanning, was demonstrat ed in 37% of patients. Bone marrow infiltration was seen in 12% of pat ients and was the only form of visceral involvement. All liver biopsie s were negative. Serum lactate dehydrogenase (LDH) levels were raised in patients with lymph node disease; it was the only laboratory test t hat correlated with extracutaneous involvement. Staging procedures cha nged three of the nine patients with a clinical T1-T2N0M0B0 stage (33% ) to a more advanced stage. The abdominal lymph node evaluation allowe d a reclassification from NO to N1 in two of nine cases (22%); one of the remaining cases was reclassified from MO to M1 on the basis of bon e marrow biopsy results. Conclusions. Our results indicate that bone m arrow biopsy is a useful investigational procedure for determining ext racutaneous disease in CTCL. Peritoneoscopy with liver biopsy rarely i s informative; however, as our study does not include a very large num ber of patients, these preliminary conclusions must be confirmed in th e future by including more cases.