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==Overview==
==Overview==
==Bone Marrow Biopsy==
==Bone Marrow Biopsy==
*A bone marrow aspiration and biopsy is a procedure in which a small amount of bone marrow and bone is removed for microscopic examination.<ref>Multiple myeloma. Canadian Cancer Society(2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/diagnosis/?region=mb#blood_chem Accessed on September, 20th 2015</ref>
*A bone marrow aspiration and biopsy is a procedure in which a small amount of bone marrow and bone is removed for microscopic examination.<ref>Multiple myeloma. Canadian Cancer Society(2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/diagnosis/?region=mb#blood_chem Accessed on September, 20th 2015</ref>
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*The percentage of plasma cells is also used in the diagnostic criteria of multiple myeloma.<ref>Multiple myeloma. Canadian Cancer Society(2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/diagnosis/?region=mb#blood_chem Accessed on September, 20th 2015</ref>
*The percentage of plasma cells is also used in the diagnostic criteria of multiple myeloma.<ref>Multiple myeloma. Canadian Cancer Society(2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/diagnosis/?region=mb#blood_chem Accessed on September, 20th 2015</ref>


;Diagnostic Criteria
==Cytogenetic tests==
In 2003, the International Myeloma Working Group agreed on diagnostic criteria for symptomatic myeloma, asymptomatic myeloma and [[monoclonal gammopathy of undetermined significance|MGUS]] (monoclonal gammopathy of undetermined significance):
*Detects any chromosomal mutations occurring in multiple myeloma such as chromosome 13 deletion or chromosome 14 translocation.<ref>Multiple myeloma. Canadian Cancer Society(2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/diagnosis/?region=mb#blood_chem Accessed on September, 20th 2015</ref>
 
;Karyotyping<ref>Multiple myeloma. Canadian Cancer Society(2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/diagnosis/?region=mb#blood_chem Accessed on September, 20th 2015</ref>
:A sample of blood or liquid bone marrow (from a bone marrow aspiration) is examined under the microscope to look for changes in the chromosomes. Karyotyping can find large chromosomal changes like a missing chromosome.


* Symptomatic myeloma:
;Fluorescent in situ hybridization (FISH)<ref>Multiple myeloma. Canadian Cancer Society(2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/diagnosis/?region=mb#blood_chem Accessed on September, 20th 2015</ref>
*# Clonal plasma cells >10% on [[bone marrow]] [[biopsy]] or (in any quantity) in a biopsy from other tissues ([[plasmacytoma]])
:FISH is a specific molecular genetic method used to identify chromosomal abnormalities and other genetic changes in cells using special DNA probes labelled with fluorescent dyes. FISH can find small chromosomal changes like a rearranged chromosome.
*# A [[monoclonal]] protein ([[paraprotein]]) in either [[blood plasma|serum]] or [[urine]]
*# Evidence of end-organ damage (''related organ or tissue impairment'', ROTI):
*#* [[Hypercalcemia]] (corrected calcium >2.75 mmol/L)
*#* [[Renal insufficiency]] attributable to myeloma
*#* [[Anemia]] (hemoglobin <10 g/dL)
*#* Bone [[lesions]] (lytic lesions or [[osteoporosis]] with compression fractures)
*#* Frequent severe [[infections]] (>2 a year)
*#* [[Amyloidosis]] of other organs
*#* [[Hyperviscosity syndrome]]
* Asymptomatic myeloma:
*# Serum paraprotein >30 g/L AND/OR
*# Clonal plasma cells >10% on bone marrow biopsy AND
*# NO myeloma-related organ or tissue impairment
* Monoclonal gammopathy of undetermined significance (MGUS):
*# Serum paraprotein <30 g/L AND/OR
*# Clonal plasma cells <10% on bone marrow biopsy AND
*# NO multiple myeloma-related organ or tissue impairment


Related conditions include ''solitary [[plasmacytoma]]'' (a single tumor of plasma cells, typically treated with irradiation), ''plasma cell [[dyscrasia]]'' (where only the antibodies produce symptoms, e.g. AL [[amyloid|amyloidosis]]), and [[POEMS syndrome]] (peripheral neuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, skin changes).


==References==
==References==

Revision as of 17:32, 21 September 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Bone Marrow Biopsy

  • A bone marrow aspiration and biopsy is a procedure in which a small amount of bone marrow and bone is removed for microscopic examination.[1]
  • It may be done in a clinic or hospital on an outpatient or in-patient basis.[2]
  • It is usually performed to estimate the percentage of bone marrow occupied by plasma cells.[3]
  • Examination of abnormal plasma in the bone marrow is the only way to confirm a diagnosis.[4]
  • The percentage of plasma cells is also used in the diagnostic criteria of multiple myeloma.[5]

Cytogenetic tests

  • Detects any chromosomal mutations occurring in multiple myeloma such as chromosome 13 deletion or chromosome 14 translocation.[6]
Karyotyping[7]
A sample of blood or liquid bone marrow (from a bone marrow aspiration) is examined under the microscope to look for changes in the chromosomes. Karyotyping can find large chromosomal changes like a missing chromosome.
Fluorescent in situ hybridization (FISH)[8]
FISH is a specific molecular genetic method used to identify chromosomal abnormalities and other genetic changes in cells using special DNA probes labelled with fluorescent dyes. FISH can find small chromosomal changes like a rearranged chromosome.


References

  1. ↑ Multiple myeloma. Canadian Cancer Society(2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/diagnosis/?region=mb#blood_chem Accessed on September, 20th 2015
  2. ↑ Multiple myeloma. Canadian Cancer Society(2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/diagnosis/?region=mb#blood_chem Accessed on September, 20th 2015
  3. ↑ Multiple myeloma. Canadian Cancer Society(2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/diagnosis/?region=mb#blood_chem Accessed on September, 20th 2015
  4. ↑ Multiple myeloma. Canadian Cancer Society(2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/diagnosis/?region=mb#blood_chem Accessed on September, 20th 2015
  5. ↑ Multiple myeloma. Canadian Cancer Society(2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/diagnosis/?region=mb#blood_chem Accessed on September, 20th 2015
  6. ↑ Multiple myeloma. Canadian Cancer Society(2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/diagnosis/?region=mb#blood_chem Accessed on September, 20th 2015
  7. ↑ Multiple myeloma. Canadian Cancer Society(2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/diagnosis/?region=mb#blood_chem Accessed on September, 20th 2015
  8. ↑ Multiple myeloma. Canadian Cancer Society(2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/diagnosis/?region=mb#blood_chem Accessed on September, 20th 2015


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