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{{Multiple myeloma}}
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==Overview==
==Overview==
==Bone Marrow Biopsy==
[[Bone marrow biopsy]] is an important [[Diagnosis|diagnostic]] test in [[multiple myeloma]]. [[Bone marrow biopsy]] consists of the collection of the [[Bone marrow biopsy|bone marrow aspirate]] and the solid core [[biopsy]]. Tests that can be performed on the [[bone marrow biopsy]] include [[karyotyping]] (chromosomal analysis) and [[immunophenotyping]].
*A bone marrow aspiration and biopsy is a procedure in which a small amount of bone marrow and bone is removed for microscopic examination.
*It may be done in a clinic or hospital on an outpatient or in-patient basis.
*It is usually performed to estimate the percentage of bone marrow occupied by plasma cells.
*Examination of abnormal plasma in the bone marrow is the only way to confirm a diagnosis.
*The percentage of plasma cells is also used in the diagnostic criteria of multiple myeloma.
 
;Diagnostic Criteria
In 2003, the International Myeloma Working Group agreed on diagnostic criteria for symptomatic myeloma, asymptomatic myeloma and [[monoclonal gammopathy of undetermined significance|MGUS]] (monoclonal gammopathy of undetermined significance):
 
* Symptomatic myeloma:
*# Clonal plasma cells >10% on [[bone marrow]] [[biopsy]] or (in any quantity) in a biopsy from other tissues ([[plasmacytoma]])
*# A [[monoclonal]] protein ([[paraprotein]]) in either [[blood plasma|serum]] or [[urine]]
*# Evidence of end-organ damage (''related organ or tissue impairment'', ROTI):
*#* [[Hypercalcemia]] (corrected calcium >2.75 mmol/L)
*#* [[Renal insufficiency]] attributable to myeloma
*#* [[Anemia]] (hemoglobin <10 g/dL)
*#* Bone [[lesions]] (lytic lesions or [[osteoporosis]] with compression fractures)
*#* Frequent severe [[infections]] (>2 a year)
*#* [[Amyloidosis]] of other organs
*#* [[Hyperviscosity syndrome]]
* Asymptomatic myeloma:
*# Serum paraprotein >30 g/L AND/OR
*# Clonal plasma cells >10% on bone marrow biopsy AND
*# NO myeloma-related organ or tissue impairment
* Monoclonal gammopathy of undetermined significance (MGUS):
*# Serum paraprotein <30 g/L AND/OR
*# Clonal plasma cells <10% on bone marrow biopsy AND
*# NO multiple myeloma-related organ or tissue impairment


Related conditions include ''solitary [[plasmacytoma]]'' (a single tumor of plasma cells, typically treated with irradiation), ''plasma cell [[dyscrasia]]'' (where only the antibodies produce symptoms, e.g. AL [[amyloid|amyloidosis]]), and [[POEMS syndrome]] (peripheral neuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, skin changes).
==Other Diagnostic Studies==


===Bone Marrow Biopsy===
*[[Bone marrow biopsy]] is usually performed in most [[patients]] with a suspected [[diagnosis]] of [[multiple myeloma]] or other [[hematologic]] [[malignancy]]. It is usually done as part of the initial [[diagnostic]] workup.
*[[Bone marrow biopsy]] is usually performed to estimate the percentage of [[bone marrow]] occupied by [[plasma cells]].<ref name="canada">Multiple myeloma. Canadian Cancer Society(2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/diagnosis/?region=mb#blood_chem Accessed on September, 20th 2015</ref>
*[[Bone marrow biopsy]] consists of both a liquid [[aspirate]] and a solid core [[biopsy]]. [[Immunophenotyping]] ([[flow cytometry]]) is usually done on the [[Bone marrow aspiration|bone marrow aspirate]] to assess for [[abnormal]] [[cells]]. Of note, [[plasma cells]] are particularly susceptible to mechanical damage by [[immunophenotyping]], so this is not the best way to assess for [[plasma cell]] burden in the [[Bone marrow|bone marrow.]] A better method is to assess the core [[biopsy]] for [[plasma cell]] content.
*[[Karyotyping]] detects any [[chromosomal]] abnormalities in [[multiple myeloma]] cells such as [[Chromosome 13 (human)|chromosome 13]] [[Deletion (genetics)|deletion]].<ref name="canada">Multiple myeloma. Canadian Cancer Society(2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/diagnosis/?region=mb#blood_chem Accessed on September, 20th 2015</ref><ref name="wiki">Multiple myeloma. Wikipedia (2015)https://en.wikipedia.org/wiki/Multiple_myeloma#Pathophysiology Accessed on September 2015</ref> [[Cytogenetics]] ([[chromosome]] analysis) can be performed on the core [[biopsy]]. [[Molecule|Molecular]] studies are usually performed on the aspirate. Certain [[Cytogenetics|cytogenetic]] abnormalities have [[prognostic]] significance.
*The percentage of [[plasma cells]] is used of one of the key [[diagnostic criteria]] of [[multiple myeloma]].<ref name="canada">Multiple myeloma. Canadian Cancer Society(2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/diagnosis/?region=mb#blood_chem Accessed on September, 20th 2015</ref> A [[diagnosis]] of [[multiple myeloma]] requires greater than 10% clonal [[Plasma cell|plasma cells]] in the [[bone marrow]].
*'''[[Fluorescent in situ hybridization]] (FISH)''' detects any [[chromosomal]] abnormalities occurring in [[multiple myeloma]] such as [[Chromosome 14 (human)|chromosome 14]] [[Translocations|translocation]].<ref name="canada">Multiple myeloma. Canadian Cancer Society(2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/diagnosis/?region=mb#blood_chem Accessed on September, 20th 2015</ref><ref name="wiki">Multiple myeloma. Wikipedia (2015)https://en.wikipedia.org/wiki/Multiple_myeloma#Pathophysiology Accessed on September 2015</ref>
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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Latest revision as of 22:47, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [2] Shyam Patel [3]

Overview

Bone marrow biopsy is an important diagnostic test in multiple myeloma. Bone marrow biopsy consists of the collection of the bone marrow aspirate and the solid core biopsy. Tests that can be performed on the bone marrow biopsy include karyotyping (chromosomal analysis) and immunophenotyping.

Other Diagnostic Studies

Bone Marrow Biopsy

References

  1. 1.0 1.1 1.2 1.3 Multiple myeloma. Canadian Cancer Society(2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/diagnosis/?region=mb#blood_chem Accessed on September, 20th 2015
  2. 2.0 2.1 Multiple myeloma. Wikipedia (2015)https://en.wikipedia.org/wiki/Multiple_myeloma#Pathophysiology Accessed on September 2015