Frequency of skeletal metastases as revealed by routinely taken bone marrow biopsies

Summary

In a total of 581 patients with the presumptive clinical diagnosis of bone marrow metastases, core biopsies of the iliac crest were performed to evaluate the frequency of infiltrates in routinely taken samples. The frequency of metastases depends greatly on the varying clinical indications to perform an examination. Staging procedures will result in a decline in positive findings whereas overt signs and symptoms of tumor spread naturally increase the rates. Thus, the annual rates have decreased from 45 to 28% during the last 5 years. The mean frequency of metastases in 501 patients with known primaries was 24%; related to particular tumors the rates were 49% in prostate, 41% in breast, 19% in thyroid and 7% in bronchogenic cancer. The patterns of bone marrow involvement displayed an overwhelming focal infiltration of the marrow space in carcinomas of the thyroid gland and bronchus, and a more diffuse extension in tumors of the prostate and breast.

It was demonstrated that neither the width or the total area of the marrow biopsies nor the site of the core is decisive in determining the yield of positive results, but the length of the cylinder may be. No differences could therefore be observed between Jamshidi's dorsal and Burkhardt's anterior crest biopsy method. The results of histopathology were compared with the findings of total body bone scanning in 209 patients. In 49% of all cases scintigrams showed lesions suggestive of metastatic spread and therefore higher frequency of occurrence than the trephine biopsy. Conversely in 23% of the patients with marrow involvement the scintigrams were negative. It is concluded that the core biopsy of the bone marrow is a most valuable aid for an early detection of bone metastases together with radiological methods and is a basal requirement for clinical staging procedures and choice of therapeutic regimens.