Staging bone marrow in diffuse large B-cell lymphoma: the role of ancillary investigations

• Published in: Pathology Vol. 41; no. 3; pp. 214 - 222
• Main Authors: Talaulikar, Dipti, Dahlstrom, Jane E.
• Format: Journal Article
• Language: English
• Published: England Elsevier B.V 01.01.2009; Informa UK Ltd
• Subjects: aspirates; B-cell lymphoma; bone marrow; Bone Marrow Neoplasms - genetics; Bone Marrow Neoplasms - pathology; Flow Cytometry; Gene Rearrangement, B-Lymphocyte, Heavy Chain; Gene Rearrangement, B-Lymphocyte, Light Chain; Humans; Immunohistochemistry; Immunophenotyping; Lymphoma, Large B-Cell, Diffuse - genetics; Lymphoma, Large B-Cell, Diffuse - pathology; molecular; Neoplasm Staging - methods; non-Hodgkin's lymphoma; prognosis; staging; trephine biopsy; trephine biopsy; non-Hodgkin's lymphoma; immunophenotyping; aspirates; flow cytometry; molecular; immunohistochemistry; prognosis; staging; bone marrow; B-cell lymphoma
• ISSN: 0031-3025; 1465-3931
• DOI: 10.1080/00313020902756295

Diffuse large B-cell lymphoma (DLBCL) is an aggressive non-Hodgkin's lymphoma (NHL) that requires treatment at initial diagnosis. Treatment decisions may be guided by staging investigations, which include assessment of bone marrow (BM). Traditionally this assessment has included light microscopic examination of the bone marrow aspirate and trephine biopsy. Ancillary testing—including immunophenotyping using flow cytometry on BM aspirates, immunohistochemistry (IHC) on BM trephines and molecular studies using immunoglobulin heavy (IgH) or light (IgL) chain gene rearrangements—are performed as required to aid histological diagnosis. This review examines the evidence for the routine use of ancillary tests in the initial staging of DLBCL, including the limitations, potential pitfalls and possible clinical implications of their use in this setting