When is a bone marrow biopsy necessary?

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leiker_shop
leiker_shop Member Posts: 10 Member

Dave's bloodwork shows slightly low levels of RBC, hemoglobin, hematocrit, platelets, and monocytes... his WBC dips in and out of low/normal range. His LDH and beta 2 microglobulin and most all the other numbers are within normal range. We are in the process of getting diagnosed right now (retroperitoneal biopsy done today, a core needle).

He has unexplained weight loss and somewhat depressed appetite, as well as weird drenching sweats. He has enlarged nodes throughout his retroperitoneal, retrocrural, gastrohepatic, paraaortic, and mediastinal areas (as well as one axillary) although they are not super big OR very avid on PET-CT (highest being 6.88).

We were kind of expecting an incisional or excisional node biopsy... and we got a core needle. We were hoping they would somehow be able to do a bone marrow biopsy while they were doing the tissue one today, but were told that's not how it works and typically they wait for the tissue results first, if at all.

Is his bloodwork worthy of a look at bone marrow? Or does it not typically matter, in terms of diagbosing subtype or staging or treatment choice, assuming they got a good tissue biopsy?

Interested to hear what you all think.

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  • ShadyGuy
    ShadyGuy Member Posts: 913 Member
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    My diagnosis was delayed because my blood work was normal. BMB showed 26% cancer cells. I was glad I chose to have the BMB. Biopsies are the only definitive way to diagnose lymphoma. Bloodwork etc are only screening tests. Good luck.

  • tgyphilly
    tgyphilly Member Posts: 49 Member
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    I would leave it to your doctors to determine that. If you want a second opinion, get it from another hematologist. Also, bone marrow biopsies are not fun.

  • po18guy
    po18guy Member Posts: 1,487 Member
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    Marrow biopsies are often done to determine staging and direct therapy post-diagnosis. Until then, the primary diagnosis would be the main thrust, I would think.

  • ShadyGuy
    ShadyGuy Member Posts: 913 Member
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    Cancer is not fun. Treatment is about survival, not “fun”. I know that BMB strikes fear in many hearts and understandably so. However I have had three BMB with one at MD Anderson in both hips at the same time. Fun? Definitely not! But neither was it horrible. It was not nearly as painful as I feared, and it was over in a very short time. It is often part of the staging process. Any cancer in the bone marrow means stage 4. Cancer cells in marrow can lead to CNS lymphoma and your doc needs to know that. That is probably why he recommended BMB. I am a big believer in second or even third opinions. A second doctor should be able to give an opinion based on your existing test resilts unless he/she wants something double checked. Best of luck to your husband and you.

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,815 Member
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    I agree with Shady here precisely. Lymphoma (and leukemia similarly) is not staged like organ cancers, and can be systemic (spread throughout the body), even at Stage 1, although at Stage 1 it has not 'taken up residence' outside of the per se lymphatic system. An aspirational biopsy is significantly inferior to an excisional one for lymphoma, and can frequently yield false negatives or misdiagnosis of strain, of which there are over 70. Incisional may be of value for a quick, inexact look at what is going on, so it is somewhat better than nothing. Most patients with confirmed lymphoma diagnosis then receive a BMB. As I said, the degree of overt spread via CT, PET or other cannot ordinarily rule out bone marrow involvement, and when there is bone marrow involvement, the diagnosis becomes Stage 4, which will change treatment duration as well as possibly drug choices and other factors. I would say that the level of discomfort, or lack thereof, in a BMB is wholly irrelevant. Virtually ever aspect of cancer treatment is somewhere between unpleasant and agonizing, so know going in that cherry-picking is ill-advised.

  • leiker_shop
    leiker_shop Member Posts: 10 Member
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    Last night we received preliminary results through our portal, and Interpretation of the flow cytometry from FNA/core needle node biopsy seems to be "CD10+ B-cell Lymphoma." While there are several CD10-positive lymphomas, when I delved into the various markers for different subtypes, the expressions matched pretty much exactly for Follicular Lymphoma (with Burkitt and a few others further behind/less likely).

    To (all of) your point(s), the second test results report (chromosome analysis, cytogenetics) stated that there were not enough WBCs in the sample to even do the test! Minimum necessary is 2mL and 3000 WBCs, and Dave's sample was "paucicellular" at 5mL but only 50 WBCs! (How is that even possible!?) Now, this was with the FNA sample... I immediately messaged the doctor asking if they needed to provide another sample, or do a BMB, or something.

    We see the oncologist/hematology at 2pm today, and hopefully he can provide some clarity on subtype with just the flow cytometry reading. That said, while I am betting it will be Grade 1-2 overall, I know WE would feel a lot better knowing if/how much the bone marrow was involved, considering his slightly low blood count. Dave is totally fine with any and all procedures; he was a paramedic and firefighter, and likes to watch that stuff being done... even on himself!

    Fingers crossed...!

  • leiker_shop
    leiker_shop Member Posts: 10 Member
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    Oh, and we are fairly certain he will be labeled Stage IV/4, just based on location of enlarged/active nodes. He has one axillary and some retrocrural (so, above diaphragm), and then lots in abdomen (paraaortic, mesenteric, iliac, retrocaval, gastrohepatic, etc.). While his stomach, liver, kidneys, spleen, and pancreas are all normal size, his pancreas IS kind of sausage-shaped which the PET scan reader listed as "likely chronic autoimmune pancreatitis." One section of his small bowel is also low-grade FDG avid and has "circumferential wall thickening" of almost 9mm, where 1-2mm is normal. So this is likely related to the tiny lymph system network material in bowel walls called Peyer's patches being affected. Not sure if that or pancreas would count as an "extranodal site"... but we are pretty much assuming he is Stage 4. We also understand it's not necessarily that important, compared to the grade seen on cell stains.

  • twowheels
    twowheels Member Posts: 31 Member
    edited March 2022 #9
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    I must have had the absolute best bone marrow biopsy procedure (fortunately that pathology was negative/ no bone marrow involvement).

    My biopsy used a bone-density seeking laser-like guide that sounded like something out of the movies.

    The technician set the guide towards a heavy bone section of my pelvis/hip, then left the specific spot to the laser sight.

    The laser/guide would line-up a spot, then (cue mechanized targeting sound-effects) veer-off a smidge, line-up again and again. Within 30 seconds, the sight chose what "it" deemed a most suitable location and proceeded to drill.

    Prior to this, I received a Lidocaine shot in the hip (similar to a dentist prepping a tooth carie). I could feel the drilling sensation but ZERO pain.

  • HarryHook
    HarryHook Member Posts: 7 Member
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    You write that he was given a needle biopsy. I was recently told I probably had lymphoma but needed a biopsy and fortunately for me, there is an oncological surgeon at my hospital who is qualified for robot-assisted micro-surgery. The hospital no longer does needle biopsies for lymphoma since they say they are not effective in providing definitive diagnosis. The surgeon made 5 circular holes in my abdomen, across my waistline and took samples of several lymph nodes and was also able to remove an entire lymph node (large - more than 7 x7.5 x 7.5 cm) through one of the incisions. They did an extensive biopsy by sectioning that node (I don't know the details) and I had the results in a couple of days. My point is this: when someone you know is getting ready for a biopsy, they should inquire about robot-assisted micro-surgery. I don't know how many surgeons are qualified, but it is quick with relatively easy side effects. I went home an hour after I woke up and I had minor abdominal pain for a few days and that's it for side effects. It would be worth traveling for it instead of being cut open for traditional surgery.