scholarly journals Correlation of bone marrow aspiration and biopsy findings in diagnosing hematological disorders - a study of 89 cases

2014 ◽  
Vol 4 (7) ◽  
pp. 534-538 ◽  
Author(s):  
S Parajuli ◽  
A Tuladhar
Keyword(s):  
Bone Marrow ◽  
Diagnostic Accuracy ◽  
Wide Spectrum ◽  
Bone Marrow Aspiration ◽  
Bone Marrow Examination ◽  
Histopathological Study ◽  
Trephine Biopsy ◽  
Aspiration Cytology ◽  
Serological Tests ◽  
Hematological Diseases

Background: Bone marrow examination is an important diagnostic tool to evaluate various disorders which includes both neoplastic and non- neoplastic hematological diseases. Few studies have compared the relative value of aspirate with trephine biopsy. The present study was conducted to compare the role of bone marrow aspirate and trephine biopsy to formulate an effective and rapid method for diagnosing wide spectrum of hematological diseases. Materials and Methods: This is a three year retrospective study done from July 2010 to June 2013. A total of 95 cases presented with clinical haematological disorders; of which only 89 were biopsied and the correlation done. All the smears and sections were reviewed for morphological details and findings on aspirate and biopsy and compared to each other. Results: Out of the 89 cases selected for study; bone marrow aspiration revealed diagnostic materials in 75 cases and 14 cases were inconclusive for a definite diagnosis. The diagnostic accuracy of the bone marrow aspiration cytology was 84.26%. Eighty eight cases were diagnosed on trephine biopsy of bone marrow with diagnostic accuracy of 98.87%. Conclusion: Both the aspiration cytology and trephine biopsy complement each other for evaluating any haematological disorder. Though cellular morphology is better understood in marrow aspirates and is equally effective to biopsy in diagnosing various anemias and leukemias; however it is the histopathological study of trephine biopsy that gives well preserved marrow architecture with its all cellular and stromal components. modalities including radiological, microbiological and serological tests. DOI: http://dx.doi.org/10.3126/jpn.v4i7.10294 Journal of Pathology of Nepal (2014) Vol. 4, 534-538

scholarly journals A Comparative Study of Bone Marrow Aspiration and Bone Marrow Biopsy in Hematological Diseases

2015 ◽  
Vol 4 (1) ◽  
pp. 12-14
Author(s):  
Nirajan Mainali ◽  
Neha Homagai ◽  
Pratap Sagar Tiwari ◽  
Arun Giri
Keyword(s):  
Bone Marrow ◽  
Diagnostic Accuracy ◽  
Bone Marrow Aspiration ◽  
Bone Marrow Examination ◽  
Diagnostic Value ◽  
Trephine Biopsy ◽  
Biopsy Material ◽  
Hematological Diseases ◽  
Bone Marrow Trephine Biopsy ◽  
Common Diagnosis

Introduction: Bone marrow examination is an important diagnostic tool to evaluate various disorder including both neoplastic and non-neoplastic hematological diseases. The two most important techniques used for the diagnosis are bone marrow aspiration and bone marrow trephine biopsy which are complementary to each other.Aim and Objectives: To compare the diagnostic value of bone marrow aspiration and biopsy. Material and methods: A total of 88cases with both bone marrow aspiration and biopsy were included in the study. All the aspirate smears were routinely stained by Jenner Giemsa while the trephine biopsy sections were stained by routine Hematoxylin and Eosin stain.. All the smears and sections were reviewed and the findings on BMA and BMB were compared and the final correlation done.Result: Hypolastic marrow was the most common diagnosis followed by immune thrombocytopenic purpura (ITP). But the diagnostic accuracy of ITP on aspiration was 100 % in compare to hypoplastic marrow (81.25%). The diagnosis accuracy of BMA in our study was 84.09%.Conclusion: Bone marrow aspiration and biopsy complement each other. Bone marrow aspiration provides better study of the cell, whereas biopsy provides detail about the pattern of cellular distribution, hence when performed together it gives better diagnostic accuracy. Journal of Nobel College of Medicine Vol.4(1) 2015: 12-14

COMPARATIVE EVALUATION OF BONE MARROW ASPIRATION AND TREPHINE BIOPSY IN PANCYTOPENIA IN VARIOUS HEMATOLOGICAL DISEASES

2021 ◽  
pp. 33-35
Author(s):  
Ajit Kumar ◽  
Monika Girdhar ◽  
Karandeep Singh ◽  
Sarvek Bajaj ◽  
Sumit Kamboj ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Biopsy ◽  
Diagnostic Yield ◽  
Bone Marrow Aspiration ◽  
Diagnostic Procedures ◽  
Bone Marrow Examination ◽  
Trephine Biopsy ◽  
Hematological Disorders ◽  
Hematological Diseases ◽  
Discordance Rate

Bone marrow examination is an important tool for the diagnosis of various hematological disorders. It involves the use of bone marrow aspiration (BMA) and bone marrow biopsy (BMB). To compare concordance and discordance rate between bone Objectives: marrow aspiration and trephine biopsy ndings in making etiological diagnosis in pancytopenia patients. A cross Material And Methods: sectional prospective study was conducted in department of pathology MAMC, Agroha on 36 cases of pancytopenia to compare the ndings of bone marrow aspiration and bone marrow biopsy. The overall concordance and discordance rate between BMA and BMB wa Results: s 63.8% and 36.2% respectively. Conclusion: It was concluded in our study that BMA and BMB are important, useful complementary diagnostic procedures which gives a higher diagnostic yield when performed simultaneously.

A comparative study of bone marrow aspirate with trephine biopsy in pancytopenia disorders

2021 ◽  
Vol 6 (3) ◽  
pp. 201-206
Author(s):  
Kavya J ◽  
Kalpana Kumari MK
Keyword(s):  
Bone Marrow ◽  
Sensitivity And Specificity ◽  
Megaloblastic Anemia ◽  
Tertiary Care ◽  
Bone Marrow Aspiration ◽  
Bone Marrow Examination ◽  
Care Hospital ◽  
Trephine Biopsy ◽  
Hematological Disorders ◽  
Hematoxylin And Eosin

Pancytopenia is commonly reported in clinical hematology practice. Due to its varied marrow pathology and underlying ailments, diagnosis is often misleading and delayed. Bone marrow examination would provide a comprehensive diagnosis of both blood and bone marrow, since aspirate investigates the cytological morphology and biopsy evaluates the cellularity, architecture, and compact marrows.To compare bone marrow aspiration and trephine biopsy results in the diagnosis of pancytopenia, and to determine the sensitivity and specificity of aspirate examination in pancytopenia diagnosis.This prospective study was conducted at a tertiary care hospital from July 2014 to June 2016. A total of 320 samples were received at the department of pathology for bone marrow examination (aspirate and biopsy). Romanowsky (Leishman) stain was used to investigate aspirate samples. All biopsy samples were processed into 3-5 μ blocks and stained using hematoxylin and eosin after decalcification with 5.5% EDTA. Data analysis was performed using SPSS19.Pancytopenia constituted 56 (18.7%) cases with the mean age of 41.79 years. Of the total pancytopenia cases, hematological disorders constituted 50 (89.3%) cases and 6 (10.7%) were non-hematological cases. Aspirate and biopsy diagnosis positively correlated in 76.79% of cases. A 100% sensitivity and specificity of aspirate diagnosis was observed in, acute myeloid leukemia, hypersplenism, myelodysplastic syndrome, megaloblastic anemia, hematological malignancy in remission and negative for lymphoma infiltrate. Aspirate had no role in diagnosis of uremic osteodystrophy and myelofibrosis, whereas leishmaniasis was diagnosed on aspirate alone.Pancytopenia includes multiple underlying ailments which requires a differential diagnosis approach. Combining both aspirate and biopsy for diagnosis would benefit the patient in prognosis as they are complementary to each other.

scholarly journals Bone marrow touch imprint smears as an adjunct to bone marrow aspiration smears in hematological disorders

2015 ◽  
Vol 5 (9) ◽  
pp. 739-746
Author(s):  
S Upadhyaya Baskota ◽  
AR Joshi ◽  
SK Singh
Keyword(s):  
Bone Marrow ◽  
Diagnostic Accuracy ◽  
Plasma Cell ◽  
Residual Disease ◽  
Bone Marrow Aspiration ◽  
Bone Marrow Examination ◽  
P Value ◽  
Plasma Cell Myeloma ◽  
Morphological Examination ◽  
Myeloid Neoplasms

Background: Morphological examination of the marrow requires a combination of a properly prepared bone marrow aspirate smear, a trephine biopsy section and an imprint of core biopsy. Some conditions often result in a dry tap and are best studied by marrow biopsy.The major drawbacks of biopsy sections are their thickness, precludingfine morphologic detail.The objective of this study was to compare the diagnostic accuracy, cellularity and cytomorphology from bone marrow biopsy core imprint smears with bone marrow aspiration smears.Materials and Methods: Imprint smears were prepared from 138 cases subjected to bone marrow examination. The bone marrow aspiration, imprint smears andbone marrow biopsy sections were examined and were categorized into five different groups on cytomorphological basis: Non-malignant alterations and normal marrow, Myeloid neoplasms, Plasma cell myeloma, myelo-infiltrative disease and absence of residual disease and further delineated into specific entities wherever necessary.Results: Out of 138 cases, non-malignant alterations and normal marrow was the largest subgroup (N=87, 63%), followed by myeloid neoplasms (N=26, 18.5%), Plasma cell myeloma (N=13, 9.4%), myelo-infiltrative disease (N=9, 6.5%) and absence of residual disease (N=3, 2.2%). The diagnostic accuracy of imprint smears was highest (92%) followed by biopsy sections (89.9%) and aspiration smears (87%). Kappa analysis showed strong agreement (>0.8) and p-value was statistically significant (<0.001) while correlating the final diagnosis.Conclusion: Imprint smear technique is a simple, rapid, inexpensive and reliable procedure. The routine use of imprint smear in the bone marrow examination will serve as an invaluable adjunct to bone marrow aspiration and biopsy.Journal of Pathology of Nepal (2015) Vol. 5, 739-746

scholarly journals Comparison of bone marrow aspiration cytology with bone marrow trephine biopsy histopathology: An observational study

2017 ◽  
Vol 9 (03) ◽  
pp. 182-189
Author(s):  
Meenu Gilotra ◽  
Monika Gupta ◽  
Sunita Singh ◽  
Rajeev Sen
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Aspiration ◽  
Bone Marrow Examination ◽  
Final Diagnosis ◽  
Trephine Biopsy ◽  
Additional Advantage ◽  
Hematological Disorders ◽  
Bone Marrow Trephine ◽  
Bone Marrow Trephine Biopsy ◽  
Underlying Disorder

Abstract INTRODUCTION: Bone marrow examination is a useful investigative tool for the diagnosis of many hematological and nonhematological disorders. Bone marrow aspiration (BMA) provides information about the numerical and cytological features of marrow cells, whereas bone marrow trephine biopsies (BMB) provide excellent appreciation of spatial relationships between cells and of overall bone marrow structure. We conducted this study with the objective of comparing the accuracy of BMA with BMB in the diagnosis of various hematological disorders. MATERIALS AND METHODS: Both BMA and BMB were performed on a total of 130 cases and a comparative evaluation was performed in 100 cases to see the complementary role of both the procedures. However, 30 cases were excluded due to inadequate BMA, BMB, or both. Immunohistochemistry (IHC) was employed whenever required. RESULTS: In our study of 100 cases, 87% of cases were confirmed on bone marrow biopsy and in remaining 13% of cases final diagnosis was achieved with the help of other ancillary investigations. These cases were excluded for calculation of concordance rate between BMA and BMB. The concordance and disconcordance rate between BMA and BMB was 72.4% and 27.6%, respectively. CONCLUSION: BMA cytology and trephine biopsy histopathology complement each other and the superiority of one method over the other depended on the underlying disorder. Furthermore, application of ancillary techniques such as flow cytometery and IHC proved to be an additional advantage in further typing of various diseases.

scholarly journals BONE MARROW STUDY IN CASES OF HAEMATOLOGICAL DISORDERS

2019 ◽  
Vol 3 (11) ◽  
Author(s):  
Dr. Atul C. Mujumdar ◽  
Dr. Akash C Chhabra
Keyword(s):  
Bone Marrow ◽  
Peripheral Blood ◽  
Bone Marrow Aspiration ◽  
Bone Marrow Examination ◽  
Parasitic Infections ◽  
Trephine Biopsy ◽  
Blood Picture ◽  
Hematological Disorders ◽  
Tissue Paper ◽  
Haematological Disorders

Introduction: There are various disorders in formation of blood in body. Bone marrow is one of them which involved variety of hematological and nonhematological disorders. Hematological disorders include myeloproliferative neoplasm (MPN), acute leukemia, hemato-lymphoid neoplasm and nutritional deficiency diseases whereas nonhematological disorders include infectious diseases infiltrating the bone marrow such as parasitic infections, tuberculosis and metastatic deposits. Bone marrows present various diseases with various clinical symptoms with the involvement of blood but peripheral blood picture alone does not reflect the nature of disease process. Depending upon the suspected diagnosis from clinical features and peripheral blood examination, that indication for bone marrow examination can be done. Examination of Bone marrow is useful in the diagnosis of both hematological and non-hematological disorders. The most important techniques used for the diagnosis of hematological disorders are trephine biopsy and bone marrow aspiration. For the interpretation of the disorder of bone marrow history, clinical finding, peripheral blood picture and other laboratory findings are required. Usually Bone marrow aspiration (BMA) alone is sufficient for the diagnosis of nutritional anaemias, most of the acute leukaemias and Immune thrombocytopenias. Diagnosis such as Trephine biopsy provides important diagnostic information myelofibrosis, granulomatous disease and bone marrow infiltration. Bone marrow aspiration is useful in making out better individual cell morphology whereas biopsy is useful in bone marrow architectural pattern and distribution. Bone marrow is nor mocellular or hypercellula resulting from ineffective hematopoiesis, increased peripheral destruction and bone marrow invasion. Therefore, bone marrow examination is extremely helpful to identify the cause of pancytopenia. Aim: The main aim of this study is to evaluate the cytological and histological pattern of various hematological disorders in bone marrow aspiration and trephine biopsy respectively. Material and Methods: During the period of 1 year 100 patient with the cases of haematological disorders were included in this study. Routinely stain like Leishman stain is used for bone marrow aspiration. Haematoxylin and eosin stain is also used for trephine biopsy. For all the cases reticulocyte count, peripheral smears, sickling test and complete hemogram were done. Special stains PAS Stain (Periodic acid schiff) was done for all ALL, AML and gauchers disease. In ALL cases Block positivity is shown. In gauchers disease, a gaucher cell shows wrinkled tissue paper appearance with PAS positivity. Reticulin stain was done in myelofibrosis and metastatic deposits. In myelofibrosis, trephine biopsy shows increase in reticulin network with coarse fibrils. Result: In all the cases bone marrow aspiration was done and among them 40 cases trephine biopsy were done. Out of total patients 57 were male and 43 were female.  And the mean age was found as 32.6 years. The findings of the bone marrow were examination. At the time of study period 50% of the study have anemias and they are predominantly megaloblastic followed by aplastic/ hypoplastic anemias. Other three cases include two metastatic deposits and one storage disorder (Gaucher’s Disease). Conclusion: Bone marrow examination is important to diagnosis, prognosis or evaluate therapeutic response for a variety of hematologic and non-hematologic problems. Nowadays, Bone marrow aspiration & bone marrow biopsy are used routinely as diagnostic procedures because it is easier and does not require advance equipments. Therefore both the procedures are complementary to each other which are helpful in further investigation and management. Keywords: Bone marrow aspiration, Trephine biopsy, Pancytopenia, Megaloblastic Anemia

scholarly journals A comparative evaluation of bone marrow biopsy and bone marrow aspiration in different haematological condition with special reference to leukaemia and lymphoma

2020 ◽  
Vol 8 (8) ◽  
pp. 2886
Author(s):  
Nidhi Verma ◽  
Priya Gupta ◽  
Amod Kumar Saroj ◽  
Preeti Singh ◽  
Veer Karuna
Keyword(s):  
Bone Marrow ◽  
Diagnostic Accuracy ◽  
Special Reference ◽  
Bone Marrow Biopsy ◽  
Bone Marrow Aspiration ◽  
Clinical History ◽  
Aspiration Cytology ◽  
Medical College ◽  
Cytological Picture ◽  
Haematological Disorders

Background: For diagnosis of haematological disorders there are three modalities to examine bone marrow, bone marrow aspiration cytology (BMA), bone marrow imprint (BMI) and bone marrow biopsy (BMB). BMA gives cytological picture; BMI also gives cytological picture but cells are less in number and BMB gives cytological as well as architectural picture. BMA alone may not be sufficient to reach diagnosis therefore the present study was undertaken to compare the above modalities. The study was conducted with the aim to perform cytomorphological evaluation of bone marrow in various haematological disorders with special reference to leukaemia and lymphoma and to compare bone marrow aspiration smears with bone marrow trephine biopsy.Methods: The present study was conducted in department of pathology, LLRM Medical College, Meerut inpatients attending the outpatient department and in-patient department of pediatrics and medicine of SVBP Hospital attached to LLRM Medical College, Meerut, over a period of one year i.e. from March 2018 to May 2019. A detailed clinical history, physical examination and laboratory examination of all the cases was done.Results: Out of 50 cases, maximum number of cases were of anemia 26/50 (52%) followed by leukemia 17/50 (34%), lymphoma 5/50 (10%), multiple myeloma 1/50 (2%), myelofibrosis 1/50 (2%), leishmaniasis 1/50 (2%) and idiopathic thrombocytopenic purpura 1/50(2%). BMA smears were compared with biopsy and concordance and discordance was established. The overall diagnostic accuracy of aspiration was 94%.Conclusions: Bone marrow examination is a safe, quick easy and cost-effective procedure with very less patient discomfort. BMA shows better cellular details when compared to BMI and BMB. BMB is diagnostic investigation in dry tap cases like aplastic anemia, myelofibrosis, myelodysplastic syndrome and metastatic tumors. In present study, concordance between BMA and BMB was seen in majority of the cases and diagnostic accuracy was 94% study concludes that bone marrow aspiration cytology and trephine biopsy complement each other and should be performed simultaneously for complete bone marrow work up and evaluation.

scholarly journals Role of Bone Marrow Trephine Biopsies in the Diagnosis of Hematological and Non-Hematological Disorders

2020 ◽  
Vol 3 (2) ◽  
pp. 347-351
Author(s):  
Kricha Pande ◽  
Arvind Kumar Sinha ◽  
Anju Pradhan ◽  
Suman Rijal ◽  
Nisha Keshari Bhatta
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Aspiration ◽  
Bone Marrow Examination ◽  
Cross Sectional Study ◽  
Trephine Biopsy ◽  
Cross Sectional ◽  
Hematological Disorders ◽  
Bone Marrow Trephine ◽  
Bone Marrow Trephine Biopsy ◽  
Conclusive Diagnosis

Introduction: Bone marrow examination has become increasingly important for the diagnosis and treatment of hematologic and other illnesses. Bone marrow aspirates along with their peripheral smears and bone marrow trephine biopsies are considered to be complementary.Materials and Methods: This hospital-based, cross-sectional study was carried out in the Department of Pathology for one year (March 2011 to March 2012) at BPKIHS, Dharan. Fortyeight adequate bone marrow aspirates along with peripheral blood smears and trephine biopsies were selected and examined. Bone marrow trephine biopsies performed simultaneously with aspirate were correlated with the other two fi ndings to arrive at a conclusive diagnosis.Results: Bone marrow aspiration and trephine biopsy were found as complementary tests in 51.8% of cases. Bone marrow trephine biopsy provided a conclusive diagnosis in 25.9% of cases where bone marrow aspiration was inconclusive. Bone marrow aspiration alone was diagnostic in 22.2% of cases. In 43.7% of cases both aspiration and trephine biopsy were unable to provide a specificdiagnosis. Bone marrow biopsy was the diagnostic investigation in cases like aplastic anemia, myelofi brosis, and hypoplastic marrow.Conclusions: This study concludes that bone marrow aspiration smear along with peripheral smear findings and marrow trephine biopsy is required to arrive at a conclusive result.

scholarly journals Clinicohaematological & Aetiological Profile of Bicytopenic / Pancytopenic Children in Dehradun, India - A 5-Year Study

2021 ◽  
Vol 10 (18) ◽  
pp. 1347-1352
Author(s):  
Neelima Bahal ◽  
Avneesh Malviya ◽  
Sana Ahuja
Keyword(s):  
Bone Marrow ◽  
Clinical Features ◽  
Bone Marrow Aspiration ◽  
Bone Marrow Examination ◽  
Megaloblastic Anaemia ◽  
Diagnostic Tools ◽  
Trephine Biopsy ◽  
Study Results ◽  
Haematological Profile ◽  
Paediatric Age

BACKGROUND Cytopenia (bicytopenia / pancytopenia) in paediatric age group patients presents with variable clinical features from pallor, fever to organomegaly. Causes vary from megaloblastic anaemia to fatal leukaemias. The purpose of the study was to evaluate the etiological and clinico-haematological profile in children with bicytopenia and pancytopenia. METHODS The present retrospective study was carried out in the section of haematology, Department of Pathology of Shri Guru Ram Rai Institute of Health and Medical Sciences, Dehradun. All paediatric cases (up to 18 yrs.) with bone marrow examination, that were presented as bicytopenia or pancytopenia by routine haematological investigations were included in the study. RESULTS A total of 126 cases were included in the study, out of which, bone marrow aspiration was done in all 126 cases and trephine biopsy was done in only 78 cases. In our study, bicytopenia and pancytopenia was seen in 57.9 % and 42.1 % cases respectively. Most cases were recorded in 2nd decade. Pallor and fever were frequently observed clinical features in both cytopenias. Splenomegaly, lymphadenopathy and hepatomegaly were observed more in bicytopenia (34.2 %, 28.8 % and 27.4 % respectively). Bleeding and petechial rash were more common in pancytopenia (30.2 % and 20.8 % respectively). Anaemia and thrombocytopenia (67.1 %) were commonest combinations of bicytopenia followed by anaemia and leucopenia (26.0 %) and thrombocytopenia and leucopenia (6.8 %). CONCLUSIONS Bone marrow aspiration and trephine biopsy are important diagnostic tools in evaluating the cases of cytopenia. Both procedures are complementary to each other. KEY WORDS Bicytopenia, Pancytopenia, Megaloblastic Anaemia, Leukemia, Children

scholarly journals COMPARATIVE EVALUATION OF BONE MARROW ASPIRATE WITH TREPHINE BIOPSY IN HEMATOLOGICAL DISORDERS AND DETERMINATION OF OPTIMUM TREPHINE LENGTH IN LYMPHOMA INFILTRATION

2013 ◽  
Vol 6 (1) ◽  
pp. e2014002 ◽  
Author(s):  
Surbhi Goyal ◽  
Usha Rani Singh ◽  
Usha Rusia
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Aspirate ◽  
High Sensitivity ◽  
High Specificity ◽  
Bone Marrow Examination ◽  
Trephine Biopsy ◽  
Hematological Disorders ◽  
Hematological Diseases ◽  
Lymphoma Involvement

Introduction- Bone marrow examination is an indispensable diagnostic tool to evaluate neoplastic and non neoplastic hematological diseases. Aims- To compare bone marrow aspirate with trephine biopsy in hematological disorders. To determine the optimum trephine preprocessing length in lymphoma infiltration. Methods – Diagnostic comparison was done between simultaneous bone marrow aspirates and trephine biopsies in 449 patients. Biopsies were fixed in formalin, decalcified in 5.5% EDTA and routinely processed. Concordance rates and validity parameters for aspirate were calculated. Three deeper sections of trephine biopsy, cut at 0.1–0.2 mm intervals, were assessed for lymphoma involvement. Proportion of biopsies showing marrow infiltration by lymphoma cells was plotted against trephine length and correlation was assessed. Results- Aspirate had a high sensitivity for acute leukemia (89.4%) and multiple myeloma (88.5%), moderate for NHL (67.6%) and nonhematopoietic metastases (58.3%) and low for aplastic anemia (38.5%) and Hodgkin lymphoma (5%). Aspirate has no role in granulomatous myelitis and myelofibrosis. Lymphoma positivity increased with trephine length, with maximum positivity (68.9%) seen in 17-20 mm group and no further gain beyond 20 mm. (lymphoma positivity ≤16mm=40.3% and ≥17mm=66.1%, p=0.0011). Conclusion- Though aspirate has a high specificity, sensitivity depends upon the type of disease. Apart from few conditions, in which aspirate alone is sufficient, biopsy is mandatory in most. Preprocessing trephine length of 17-20 mm examined at multiple deeper levels was found optimal for assessing lymphoma positivity.

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