Diagnosis of bone marrow metastases in children with solid tumors and lymphomas: Aspiration, or unilateral or bilateral biopsy?

Background. Malignancies are among the most common causes of death in child ren. The present study was undertaken to evaluate and compare bone man-ow a spiration and unilateral biopsy to detect bone marrow metastases in pediatr ic patients, using bilateral biopsy as the gold standard. Methods. During a 6-month period, 63 consecutive newly diagnosed children w ith confirmed malignant diseases other than leukemia were evaluated for bon e marrow metastases or infiltration. Biopsies were obtained From both right and left posterior iliac crests whereas aspiration was performed only at t he right crest. Interpretation to the right side biopsy was considered as t he unilateral biopsy result, whereas the bilateral biopsy result was as fol lows: positively was accepted if one or both of the two-side samples were q ualified as positive, while a negative result was considered only if both s ides were negative. The bilateral biopsy was considered the gold standard, and sensitivity, specificity, positive and negative predictive value, and f alse positive and negative rates were computed fur the unilateral biopsy an d aspiration procedure. Results. We identified bone marrow metastases in 11 (17.5%) patients. The s ensitivity was the only significant difference (p <0.05) observed between u nilateral biopsy and aspiration. Finally, of the 63 patients. unilateral bi opsy was reported as inadequate in one patient (1.6%), while aspiration was inadequate in two (3.2%). Conclusions. Unilateral biopsy was better than bone marrow aspiration. Howe ver. because bilateral biopsy is the go standard, we recommend using this a nd bone marrow aspiration simultaneously to evaluate a pediatric patient wi th any malignancy potentially infiltrating bone marrow. (C) 2000 IMSS. Publ ished by Elsevier Science Inc.