# Practical diagnostic approach to assess myeloid and precursor cell neoplasms on trephine bone marrow biopsies: reflection of middle European reality

## TL;DR

This paper outlines a practical approach for diagnosing myeloid and precursor cell neoplasms using bone marrow biopsies in settings with limited access to advanced diagnostic tools.

## Contribution

The paper provides a detailed diagnostic workflow for TBMB in myeloid neoplasms, tailored to middle European healthcare realities.

## Key findings

- TBMB can be the sole diagnostic sample in the absence of other tests.
- Combining histopathology, immunohistochemistry, and sequencing improves diagnostic accuracy.
- A practical approach is proposed to achieve robust conclusions with limited resources.

## Abstract

Trephine bone marrow biopsies (TBMB) are standard specimens for diagnostics and follow-up of myeloid and precursor cell neoplasms, usually as part of a multimodal approach including complete blood count (CBC) tests, cytologic assessment of BM aspirate smears, flow cytometry, cytogenomics, and molecular genetics. Incorporating the results of all the above methods or running all tests within one specialized lab and providing an integrative report is ideally desirable. However, in reality, in many countries, (1) diagnostic (hemato-)pathologists may not have access to information on the results obtained by other technologies except for a CBC, (2) individual procedures may not be available at all, (3) specimens may not be submitted to specialized labs, or (4) particular technologies may fail yielding results (e.g., dry taps or specimens with destroyed nucleic acids), so that the TBMB might remain the only analytic sample. The detailed description of our approach to handling TBMB including classic histopathology, immunohistochemistry, fluorescence in situ hybridization, and sequencing techniques in the setting of myeloid and precursor neoplasms may help the readership to achieve a comprehensive TBMB diagnostic approach reaching more definite and robust conclusions to improve patient care.