KEMİK İLİĞİ METASTAZI OLAN SOLİD MALİGNİTELİ HASTALARDA KLİNİK VE LABORATUVAR PARAMETRELERİNİN ÖNEMİ-TEK MERKEZ DENEYİMİ

Year 2023, , 187 - 191, 30.12.2023

Sevil Sadri , Jamshid Hamdard , Huseyin Saffet Bekoz , Aslı Çakır , Omer Fatih Olmez , Ahmet Bilici

https://doi.org/10.52831/kjhs.1271864

Abstract

Amaç: Solid tümörlerde kemik iliği biyopsisi, kemik iliği tutulumunun tanısında etkili ve kesin bir tanı yöntemidir. Son yıllarda, kemik iliği incelemesi tümörlerin metastatik tutulumunu belgelemede giderek daha kullanışlı hale gelmiştir.
Yöntem: Merkezimizde solid malignitesi olan ve hematolojik parametrelerinde anormallikleri olan hastaların periferik kan morfolojisi değerlendirildi. Hasta özellikleri; periferik kan sayımları, periferik kan morfolojisi, önceki tedavilerini dahil edecek şekilde kaydedildi. Bu çalışmanın amacı; solid kanserli hastalarda açıklanamayan hematolojik anormallikler için kemik iliği biyopsisi ve aspirasyonunu incelemek, bu tür hastaların patolojik bulgularını, klinik ve hematolojik laboratuvar özelliklerini ve sonuçlarını kurumumuzda araştırmaktı. Ayrıca bu hastaların yönetimi ve sağkalımı ile ilgili detaylar bildirildi.
Bulgular: Kemik iliği biyopsi tutulumu olmayan grupta daha düşük RDW-Cv değeri, kemik iliği biyopsi tutulumu olan gruba göre istatistiksel olarak anlamlı bulundu (p=0,005; p<0.01). Kemik iliği biyopsisi tutulumu olmayan grubun fibrozis değerinin kemik iliği biyopsisi tutulumu olan gruba göre daha düşük olması istatistiksel olarak anlamlı bulundu (p=0.016; p<0.05). Kemik iliği biyopsi tutulumu olmayan grubun LDH değerinin kemik iliği biyopsi tutulumu olan gruba göre daha düşük olması istatistiksel olarak anlamlı bulundu (p=0,002; p<0.01). Kemik iliği biyopsi tutulumu ile periferik yayma bulguları (p=0.001; p<0.01), PET-BT'de kemik iliği tutulumu (p=0.001; p<0.01), anemi (p=0.028; p<0.05) ve kemik metastazı (p=0.001; p<0.01) arasında istatistiksel olarak anlamlı ilişki bulundu.
Sonuç: Bu çalışmanın sonucunda klinik pratikte açıklanamayan hematolojik anormallikler, özellikle açıklanamayan anemi ve yüksek RDW ve LDH parametreleri saptandığında kemik iliği metastazı şüphesi düşünülmeli ve kesin tanı için kemik iliği biyopsisi önerilmektedir.

Keywords

Solid Tümör, Kemik İliği Biyopsi, Metastaz

THE IMPORTANCE OF CLINICAL AND LABORATORY PARAMETERS OF BONE MARROW METASTASIS IN PATIENTS WITH SOLID MALIGNANCY-SINGLE CENTER EXPERIENCE

Abstract

Objective: Bone marrow biopsy is an efficient and reliable diagnostic procedure for the identification of bone marrow involvement. In recent years, bone marrow examination has become more helpful in documenting the metastatic involvement of malignancies.
Method: Patients with solid tumors and anomalies in hematological parameters had their peripheral blood morphology examined at our facility. Each instance included information on the patient's peripheral blood counts, peripheral blood morphology, and prior therapies. The purpose of this study was to analyze bone marrow biopsy and aspiration for unexplained hematological abnormalities in solid cancer patients and to look into the pathological findings, clinical and hematological laboratory features, and outcomes of such patients in our facility. Additionally, we provided information on the treatment and prognosis of these patients.
Results: When compared to the group that had bone marrow biopsy involvement, the lower RDW-Cv value in the former group was shown to be statistically significant (p=0.005; p<0.01). It was determined that the difference between the fibrosis values of the groups with and without bone marrow biopsy involvement was statistically significant (p=0.016; p<0.05). It was determined to be statistically significant (p=0.002; p<0.01) that the LDH value of the group without bone marrow biopsy involvement was lower than that of the group with BM biopsy involvement. Anemia (p=0.028; p<0.05), bone metastases (p=0.001; p<0.01), bone marrow biopsy involvement in PET-CT (p=0.001; p<0.01), and peripheral smear results (p=0.001; p<0.01) all showed a statistically significant correlation.
Conclusion: In conclusion, bone marrow metastasis should be considered when inexplicable hematological abnormalities, particularly unexplained anemia, and elevated RDW and LDH parameters are found in clinical practice. A bone marrow biopsy is advised for a conclusive diagnosis.

Keywords

Solid Malignancy, Bone Marrow Biopsy, Metastasis

References

• Krishnan C, George TI, Arber DA. Bone marrow metastases: a survey of nonhematologic metastases with immunohistochemical study of metastatic carcinomas. Appl Immunohistochem Mol Morphol. 2007;15(1):1-7.
• Barekman CL, Fair KP, Cotelingam JD. Comparative utility of diagnostic bone-marrow components: a 10-year study. Am J Hematol. 1997;56(1):37-41.
• Banys M, Solomayer EF, Becker S, et al. Disseminated tumor cells in bone marrow may affect prognosis of patients with gynecologic malignancies. Int J Gynecol Cancer. 2009;19(5):948-952.
• Fischer BM, Mortensen J, Langer SW, et al. A prospective study of PET/CT in initial staging of small-cell lung cancer: comparison with CT, bone scintigraphy and bone marrow analysis. Ann Oncol. 2007;18:338-345.
• Chernow B, Wallner SF. Variables predictive of bone marrow metastasis. Cancer. 1978;42(5):2373-2378.
• Papac RJ. Bone marrow metastases. A review. Cancer. 1994;74(9):2403-2413.
• Kaur G, Basu S, Kaur P, Sood T. Metastatic bone marrow tumors: Study of nine cases and review of the literature. J Blood Disord Transfus. 2011;2(3):110.
• Kilickap S, Erman M, Dincer M, Aksoy S, Hakan H, Yalcin Y. Bone marrow metastasis of solid tumors: clinicopathological evaluation of 73 cases. Turk J Cancer. 2007;37(3):85-88.
• Wong KF, Chan JK, Ma SK. Solid tumour with initial presentation in the bone marrow--a clinicopathologic study of 25 adult cases. Hematol Oncol. 1993;11(1):35-42.
• Mohanty SK, Dash S. Bone marrow metastasis in solid tumors. Indian J Pathol Microbiol. 2003;46(4):613-616.
• Sharma S, Murari M. Bone marrow involvement by metastatic solid tumors. Indian J Pathol Microbiol. 2003;46(3):382-384.
• Chauhan K, Jain M, Grover S, Shukla P, Rusia U, Grover RK. Bone marrow metastasis in nonhematologic malignancies: Data from a cancer hospital. Clin Cancer Investig J. 2016;5:103-109.
• Ingle JN, Tormey DC, Bull JM, Simon RM. Bone marrow involvement in breast cancer: Effect on response and tolerance to combination chemotherapy. Cancer. 1977;39(1):104-111.
• Ozkalemkas F, Ali R, Ozkocaman V, et al. The bone marrow aspirate and biopsy in the diagnosis of unsuspected nonhematologic malignancy: a clinical study of 19 cases. BMC Cancer. 2005;5:144.
• Yun HK, Shin MG, Bo D, et al. Laboratory evaluation of bone marrow metastasis: single institute study. Korean J Lab Med. 2007;27(2):96-101.
• Aksoy S, Kilickap S, Hayran M, et al. Platelet size has diagnostic predictive value for bone marrow metastasis in patients with solid tumors. Int J Lab Hematol. 2008;30(3):214-219.
• Demir L, Akyol M, Bener S, et al. Prognostic evaluation of breast cancer patients with evident bone marrow metastasis. Breast J. 2014;20(3):279-287.
• Chou WC, Yeh KY, Peng MT, et al. Development and validation of a prognostic score to predict survival in adult patients with solid tumors and bone marrow metastases. Medicine (Baltimore). 2015;94(23):e966.
• Navone R, Colombano MT. Histopathological trephine biopsy findings in cases of 'dry tap' bone marrow aspirations. Appl Pathol. 1984;2(5):264-271.
• D'Angelo G, Hotz AM. Myelophthisis in breast cancer. Am J Hematol. 2011;86(1):70-71.
• Makoni SN, Laber DA. Clinical spectrum of myelophthisis in cancer patients. Am J Hematol. 2004;76(1):92-93.
• Kopp HG, Krauss K, Fehm T, et al. Symptomatic bone marrow involvement in breast cancer-clinical presentation, treatment, and prognosis: a single institution review of 22 cases. Anticancer Res. 2011;31(11):4025-4030.
• Khan S, Awan SA, Jahangir S, Kamran S, Ahmad IN. Bone Marrow Metastasis in Clear Cell Renal Cell Carcinoma: A Case Study. Cureus. 2019;11(3):e4181.
• AljadayehM, SaidatS, KamalN, Obeidat M. Comparative evaluation between bone marrow aspirate and biopsy morphological findings, Experience at King Hussein Medical Center. J Royal Med Serv. 2015;22(2):18-22.
• Katiyar G, Arya A, Kumar P. Bone marrow aspiration; role and significance in haematological disorders. Indian J Appl Res. 2017;7(10):3-5.
• Zhou MH, Wnag ZH, Zhou HW et al. Clinical outcome of 30 patients with bone marrow metastases. Journal of cancer Research and Therapeutics. 2018;9(14):512-515.