Bone marrow involvement in non‐Hodgkin's lymphoma: increased diagnostic sensitivity by combination of immunocytology, cytomorphology and trephine histology

Diagnostic results from cytomorphology and immunocytology of aspirated bone marrow (BM) were compared with the findings from standard trephine histology of 100 adult patients with non‐leukaemic non‐Hodgkin's lymphomas (NHL) in a retrospective study. Immunocytological investigations were performed by the immunoenzymatic APAAP‐technique on BM smears monoclonal antibodies against CD19, CD3, CD10 or TdT antigens and determination of positive cells in relation to total BM leucocytes. Corresponding results were obtained for trephine histology and for the combination of cytomorphology and immunocytology in 93/100 cases. Four cases with BM involvement by trephine histology were missed by the combination of immunocytology and cytomorphology. In turn, three cases negative by trephine histology, were found to be positive by the combination of immunocytology and cytomorphology. Immunocyto‐chemistry considerably increased the number of true positive detected BM‐infiltrations by cytomorphology in low grade B‐cell lymphoma from 58% to 97%. For the diagnosis of BM involvement in high‐grade NHL cytomorphology of the aspirate was of equal sensitivity to the biopsy and was always confirmed by immunocytology. The high diagnostic sensitivity of immunocytology was mainly due to high B‐cell counts in BM involved by B‐cell lymphoma (x=38%, s= 23) in contrast to low B‐cell counts in BM not involved by NHL (x=4·5%, s= 3·8). We conclude from our data that immunocytology in addition to standard cytomorphology improves diagnostic sensitivity in the detection of BM involvement by NHL.