Clinicopathological Correlations in Adult Bone Marrow Biopsies: Indications, Preliminary Diagnoses, and Histopathological Outcomes in 698 Cases

Objective: This study aimed to analyze the demographic characteristics, clinical preliminary diagnoses, biopsy indications, and histopathological findings of adult bone marrow biopsies to construct a framework that aids clinicians and pathologists in evaluating bone marrow biopsy results. Materials and Methods: Bone marrow biopsy reports from 900 cases referred to the Department of Internal Diseases Hematology at Afyonkarahisar Health Sciences University from January 1, 2017, to December 31, 2021, were retrospectively analyzed. Patients with insufficient material (18) and those sent for treatment response evaluation (184) were excluded, resulting in 698 patients being included in the study. Data analysis was performed using SPSS v26, employing the McNemar test to assess clinicopathological concordance, with a significance level set at p< 0.05. Results: Of the 698 patients analyzed, 388 (55.6%) were male and 310 (44.4%) were female, with ages ranging from 18 to 87 years. The most common indications for biopsy were lymphoma (16.09%), pancytopenia (16.05%), and anemia with a high sedimentation rate (14.06%). The most frequently noted preliminary diagnosis was myeloma (22.02%), followed by lymphoma (16.09%) and acute leukemia (10.03%). Significant clinicopathological concordance was observed in diagnoses such as aplastic anemia and lymphoplasmacytic lymphoma, whereas discordance was noted in conditions such as follicular lymphoma and acute myeloid leukemia (AML), reflecting the complexity and challenge of accurate diagnosis in hematologic conditions. Conclusion: This study documented a high incidence of lymphoma and myeloma as preliminary diagnoses, with myeloma confirmed in 52% of cases with an initial suspicion based on clinical presentation. Notable discrepancies between clinical suspicion and histopathological findings were evident in conditions such as follicular lymphoma and acute myeloid leukemia (AML), with a significant discordance rate. These findings highlight the need for enhanced diagnostic precision and the development of sophisticated diagnostic algorithms to improve the predictive accuracy of preliminary clinical diagnoses. Ultimately, this study calls for a refined approach to the clinical and pathological evaluation of bone marrow biopsies to better support therapeutic decision making and patient management.