X-Ray and Fine Needle Aspiration Diagnose Myeloma

The study, conducted by researchers at the department of radiology, Karolinska Hospital (Stockholm, Sweden), was published in Cytopathology (2001;12(3):157-167).

The study involved patients referred to the hospital because of a skeletal destruction of unknown origin. All underwent a routine radiographic exam and FNAC. Among them were 83 patients with solitary bone lesions diagnosed and treated for myeloma (plasmacytoma) or non-Hodgkin's lymphoma. When the researchers reviewed the series, they found that myeloma could not be distinguished radiographically from lymphoma. They also found that low and high grade lymphoma lesions could not be differentiated by radiographic appearance. The usefulness of radiography appeared to be limited to the detection of a destructive bone lesion and FNAC visual guidance. This visual guidance, nonetheless, is a crucial part of applying FNAC to bone lesions.

A review of the cytologic specimens obtained by FNAC showed that they provided a conclusive diagnosis in all 40 myeloma cases and in 41 of 43 lymphoma cases. In 32 of the 40 myeloma cases, the FNAC material could be used for immunocytochemistry, which corroborated the cytomorphologic diagnosis. These results show that the use of FNAC obviates the need for other modalities, including biopsy, in diagnosing primary myeloma and lymphoma of bone. Combining radiology and FNAC in an outpatient procedure, offers a rapid and accurate diagnosis among patients with radiographically unclassified destructive bone lesions.





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