UTILITY OF BONE MARROW ASPIRATION AND BIOPSY (BMAB) IN INITIAL STAGING OF EWING SARCOMA (EWS)
description
Transcript of UTILITY OF BONE MARROW ASPIRATION AND BIOPSY (BMAB) IN INITIAL STAGING OF EWING SARCOMA (EWS)
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