Vol. 67 • No. 3
LETTERS TO THE EDITOR
hemorrhage from the preceding aspiration or because
the specimen consisted more or less entirely of
cortical bone and cartilage. In only 2% of specimens
(15 cases) were both the aspirate section and trephine
biopsy inadequate by the above criteria. In 6% of the
specimens (41 cases), significant features such as
metastic tumor or granulomas were found in the
trephine specimen but not in the particle section.
In 3% of the specimens (18 cases), however,
the reverse was true, and the particle section revealed
pathologic conditions not present in the biopsy core.
Further analysis indicated that a certain few clinicians consistently obtained large (1.5 to 2 cm) marrow
cores, while some others seldom submitted a core
longer than 0.5 cm, and that the same was true with
regard to aspirated particles. Only exceptionally did a
given physician consistently obtain equally generous
samples of aspirated and trephined marrow.
I have drawn the following conclusions from this
study: (1) There are no clear-cut and consistent advantages to either the concentrated particle section or
the trephine biopsy technic when performed in a
medical center such as ours by a number of physicians
with varying experiences in these technics. In the
hands of experts such as Dr. Rywlin, who have
developed and perfected certain technics, one or the
other manner of obtaining marrow may be superior,
but these are exceptions to the rule. (2) The results of
large controlled studies using both methods will vary
depending upon the exact technic used and the exJo the Editor: — It seems to us that the recent
controversy regarding bone marrow aspiration versus
biopsy has produced some confusion as to which
method is superior.1,3'5
In our opinion, in the study of bone marrow everything is important: smears, sections of particles, bone
biopsy, cytochemistry and the touch preparation of the
bone biopsy in cases of "dry tap." Furthermore, it is
suggested that in the bone marrow tray a vial containing 2 ml of cold buffered glutaraldehyde should
also be included, so that electron microscopy may subsequently be utilized when light microscopy fails to
reveal the nature of the lesion. In addition, it is equally
important to consider the method offixationof particles
and bone biopsy for light microscopic study. Although
smears provide excellent cellular details with sections
of marrow particles and bone marrow biopsies,2 one
can better evaluate the overall cellularity, the myeloid:
Received October 20, 1976; accepted for publication October 20,
1976.
Key words: Bone marrow; Particle section; Trephine biopsy.
Address reprint requests to Dr. Coppola.
309
perience of the physician obtaining the specimen. (3)
I agree with Dr. Drewinko that both a concentrated
particle section and a trephine biopsy should be obtained in all cases where possible, in addition to the
usual marrow smear. The procedure of obtaining both
adds little, if any, risk or discomfort to the patient
when performed as outlined above. Most important is
the fact that it yields more marrow for a study than
either technic alone in the hands of most physicians,
thereby minimizing the possibility of an inadequate
study and increasing the chances of obtaining meaningful information regarding the marrow in the patient
under study.
RICHARD S. NEIMAN, M.D.
Hematopathology Section
Mallory Institute of Pathology
Boston City Hospital
Boston, Massachusetts 02118
References
1. Drewinko B: Dr. Drewinko's reply. Am J Clin Pathol 66:618,
1976
2. Frankel K: Bone marrow biopsy and aspiration. Am J Clin
Pathol 66:616-617, 1976
3. Lukes RJ, Tindle BT: An approach to bone marrow evaluation
by pathologists, International Congress Series No. 285, Anatomic and Clinical Pathology, Proceedings of the VIII
World Congress of Anatomic and Clinical Pathology,
Munich, 12-16 September 1972. Amsterdam, Excerpta
Medica, pp 86-92
4. Rywlin AM: Bone marrow histology, aspiration versus biopsy.
Am J Clin Pathol 66:617-618, 1976
erythroid ratio cellular morphology, adequacy of megakaryocytes, and status of iron store. We feel that all
these can be evaluated best when tissues are properly
fixed in B-5 fixative.4
ANTONIO COPPOLA, M.D.
THOMAS ATHANASSIADES, M.D.
Department of Pathology
Downstate Medical Center
State University of New York
Brooklyn, New York 11203
References
1. Dee JW, Valdivieso M, Drewinko B: Comparison of the
efficacies of closed trephine-needle biopsy, aspirated, paraffin-embedded clot section, and smear preparation in the diagnosis of bone marrow involvement by lymphoma. Am J
Clin Pathol 65:183-194, 1976
2. Hyon BH, Ashton JK, Dolan K: Practical Hematology. Philadelphia, London, Toronto, W. B. Saunders, 1975
3. Frankel K: Bone marrow biopsy and aspiration. Am J Clin
Pathol 66:616-617, 1976
4. Lillie RD: Histopathologic Technic and Practical Histochemistry. Third edition. New York, McGraw-Hill, 1965
5. Rywlin AM: Bone marrow histology, aspiration versus biopsy.
Am J Clin Pathol 66:617-618, 1976