骨髓组织活检诊断骨髓转移癌及血液病价值

Value of bone marrow biopsy to the diagnosis of metastatic carcinoma of bone marrow and hematological diseases

目的探讨骨髓活检在骨髓转移癌及血液病诊断中的价值。方法 391例骨髓转移癌及血液病患者均行骨髓穿刺涂片、骨髓活检切片组织病理检查,镜下观察骨髓增生情况,比较2种方法单独及联合诊断的符合率。结果骨髓涂片显示,骨髓增生极度活跃64例(16.37%),明显活跃83例(21.23%),活跃115例(29.41%),减低99例(25.32%),重度减低30例(7.67%);骨髓活检组织切片显示,骨髓增生极度活跃81例(20.72%),明显活跃156例(39.90%),活跃91例(23.27%),减低54例(13.81%),重度减低9例(2.30%),增生明显活跃、增生减低及增生重度减低比率比较差异均有统计学意义(P<0.011);与临床诊断结果进行比较,骨髓涂片与骨髓活检联合诊断符合率(97.44%)高于骨髓涂片(69.05%)、骨髓活检(89.00%)(P<0.05),骨髓活检高于骨髓涂片(P<0.05);骨髓活检诊断骨髓转移癌(100.00%)、淋巴瘤(76.74%)、骨髓纤维化(100.00%)、原始细胞过多的难治性贫血(93.88%)、再生障碍性贫血(94.83%)、恶性组织细胞白血病(71.43%)、多发性骨髓瘤(100.00%)和骨髓硬化症(100.00%)符合率高于骨髓涂片(77.78%、44.20%、28.95%、57.14%、81.03%、57.14%、73.33%、0)(P<0.05),诊断环形铁粒幼细胞难治性贫血(6.67%)、难治性贫血伴多系病态造血(38.46%)的符合率低于骨髓涂片(100.00%、92.31%)(P<0.05)。结论骨髓穿刺、骨髓活检在骨髓转移癌及血液病诊断中各有优势,二者联合可提高诊断准确率。

Objective To explore the value of bone marrow biopsy to the diagnosis of metastatic carcinoma of bone marrow and hematological diseases. Methods Bone marrow smear and bone marrow biopsy section were done in 391 patients. The bone marrow hyperplasia was observed under microscope. The diagnostic coincidence rates of single and joint pathologic examination methods were compared. Results Bone marrow smear showed extremely active hyperplasia in 64 patients （16.37%）, obviously active in 83 （21.23%）, active in 115 （29.41%）, lowered active in 99 （25.32%） and greatly lowered active in 30 （7.67%）. Bone marrow biopsy section showed extremely active hyperplasia in 81 patients （20.72%）, obviously active in 156 （39. 90%）, active in 91 （23. 27%）, lowered active in 54 （13.81%） and greatly lowered active in 9 （2.30%）. There were significant differences in the proportions of obviously active, lowered active and greatly lowered active hyperplasia between two methods （P〈0.01）. The diagnostic coincidence rate of joint examinations was 97.44% in comparison with clinical diagnosis results, higher than that of bone marrow smear （69.05 %） and hone marrow biopsy sections （89.00 %） （P〈0.05）, and the diagnostic coincidence rate of bone marrow biopsy sections was higher than that of bone marrow smear （P〈0.05）. The diagnostic coincidence rate of bone marrow biopsy sections was 100.00% for metastatic carcinoma of bone marrow, 76.74% for lymphoma, 100.00% for myelofibrosis, 93. 88% for refractory anemia with excess blasts, 94.83M for aplastic anemia, 71.43 % for malignant histiocyte leukemia, 100.00% for multiple myeloma and 100. 00% for myelosclerosis higher than those of bone marrow smear （77. 78%, 44.20%, 28.95%, 57.14%, 81. 03%, 57. 14%, 73. 33%, 0） （P〈0.05）, and was lower for refractory anemia with ringed sideroblast （6.67%） and refractory anemia complicated with refractory cytopenia with multilineage dysplasia （38.46 %） than those o{ bone marrow smear （100.00%, 92.31%） （P〈0.05）. Conclusion Both bone marrow smear and bone marrow biopsy section have its own advantages, and joint examination can increase the diagnostic rate of metastatic carcinoma of bone marrow and hematological diseases.