Post on 21-Mar-2016
description
UTILITY OF BONE MARROW ASPIRATION AND BIOPSY (BMAB) IN INITIAL STAGING
OF EWING SARCOMA (EWS)
Lisa M. Kopp, Winston W. Huh, Cynthia E. Herzog, Chengcheng Hu, Andrea White-Collins, Beatriz Rozo, Angela Yarborough, Pooja Hingorani
Background
• Pediatric and adolescents patients with newly diagnosed Ewing Sarcoma (EWS) have a bilateral bone marrow aspiration and biopsy (BMAB) performed as part of the initial staging evaluation
• BMAB is a painful procedure that is performed using general anesthesia
Background
• The NCCN guidelines on bone cancer recommend the option of either a BMAB or MRI of the spine and pelvis in newly diagnosed adult patients
• The necessity of a BMAB in staging pediatric and adolescent EWS patients in addition to radiological evaluation has not been previously established
Objectives
• To evaluate the association between imaging determined non-metastatic EWS and BM metastasis in pediatric and adolescent patients
• To evaluate the association between BM metastasis and other clinical characteristics of pediatric and adolescent EWS patients
Methods• Retrospective review involving 3 institutions
• Eligibility: Patients less than 40 years of age with newly diagnosed EWS between the years 2000-2012; available initial staging scans and BM evaluation
• 116 patients
• Initial staging reviewed– Imaging (MRI primary site, CT chest, Bone scan) – Bone Marrow Aspiration and Biopsy
Patient CharacteristicsNon-metastatic
(n=85) Metastatic (n=31)
Gender Male Female
47 (55.3%)38 (44.7%)
18 (58.1%)13 (41.9%)
Age at Diagnosis* 13 (1, 38) 16 (3, 25)Primary Tumor Site Pelvis Non-pelvis
15 (17.6%)70 (82.4%)
14 (45.2%)17 (54.8%)
Primary Tumor Size (cm)*, ** 7.5 (1.3, 26.0) 11.2 (3.5, 35.0)
* Median (range)** Primary tumor size of metastatic patients was significantly higher that that of non-metastatic patients (p-value = 0.017 by Wilcoxon rank-sum test)
Metastatic Patients
• Metastatic site:
• Patients with multiple metastatic sites:
Lung alone Bone alone BM alone Multiple
13 (41.9%) 2 (6.5%) 0 (0.0%) 16 (51.6%)
Lung Bone BM Lymph Nodes
9 (56.3%) 14 (87.5%) 13 (81.3%) 2 (12.5%)
BMAB Results
• None of the 85 non-metastatic patients determined by imaging had positive BMAB
• A positive pelvic primary site was not correlated with a positive bone marrowBMAB Correlation with pelvic primary site (n=116)
Pelvic Non-Pelvic P-value
BMAB positive 6 70.087
BMAB negative 23 80
BMAB Results
• 13 of 31 metastatic patients by imaging had positive BMAB
Number of Bony Metastatic Sites (bone scan, n=28)
BMAB positive BMAB negative P-value
3.5 (1.0, 11.0) 0.0 (0.0, 2.0) < 0.0001
Association of Metastasis by Imaging and BMAB
BMAB ResultsBone Metastasis Lung Metastasis
Yes No Yes No
Positive 12 1 6 7
Negative 4 14 16 2
P-value for association* 0.0002 0.017
*Fisher’s exact test was used to evaluate association.
Conclusion
• Pediatric and adolescent Ewing sarcoma patients with non-metastatic disease by imaging may have a bone marrow aspiration and biopsy eliminated as part of initial staging
• In patients with metastatic disease there is a high correlation between bone marrow metastasis and the number of bony metastatic sites
Acknowledgments
University of Arizona
• Phoenix Children’s Hospital– Pooja Hingorani, MD– Andrea White-Collins, NP
• University of Arizona – Mel and Enid Zuckerman College of Public Health– Chengcheng Hu, PhD
University of Texas MD Anderson Cancer Center Children’s Cancer Hospital
– Winston W. Huh, MD– Cynthia E. Herzog, MD, MPH– Beatriz Rozo, NP– Angela Yarbarough, NP