Diagnosis of skeletal lymphoma and myeloma by radiology and fine needle aspiration cytology

From 1986 to 1998, all patients referred to Karolinska Hospital because of a skeletal destruction of unknown origin routinely underwent radiographic e xamination and fine needle aspiration cytology (FNAC). Among these, there w ere 83 patients with solitary lesions of the bone diagnosed and treated for myeloma (plasmacytoma) or non-Hodgkin's lymphoma. Review of the series sho wed that myeloma could not be distinguished radiographically from lymphoma. Nor could low and high grade lymphoma lesions be discriminated by radiogra phic appearance. The diagnostic utility of plain radiography in the two con ditions seems to be confined to the mere detection of a destructive bone le sion and visual guidance for FNAC. The latter aspect, however, is crucial f or the application of FNAC to bone lesions. Review of the cytologic specime ns obtained by FNAC showed that they allowed a conclusive diagnosis in all 40 myeloma cases and in 41 of 43 lymphoma cases. In 32 of the 40 myeloma ca ses, the FNAC material could be used for immunocytochemistry, which disclos ed K or h light chain restriction, corroborating the cytomorphological diag nosis. Thirty-eight lymphomas were characterized immunologically and in 35, a light chain restriction could be demonstrated. Our results show that the use of FNAC in the diagnosis of primary myeloma and lymphoma of bone obvia tes the need for other diagnostic modalities, including open biopsy. A comb ined approach based on radiology and FNAC, performed as an out-patient proc edure, offers rapid and accurate diagnosis of myeloma and lymphoma among pa tients with radiographically unclassified destructive bone lesions.