Making the most of bone marrow trephine biopsy

Bone marrow trephine biopsy is an integral component of the diagnosis, staging and follow‐up of many haematological diseases. Adequate size and integrity of the initial specimen are crucial, although data defining what constitutes an adequate sample in different clinical contexts are limited. The requirement for decalcification or plastic embedding during tissue processing poses additional challenges for histological quality and successful application of essential techniques, including immunohistochemistry, DNA/RNA in situ hybridization and polymerase chain reaction. These challenges, however, can be addressed by careful attention to technical methods, some of which require modification from standard methods applied to other tissues in histopathology laboratories. Individuals reporting bone marrow trephine specimens must have sufficient understanding of haematopoietic and stromal components, and how these are affected by a wide range of diseases, to extract maximum information to support clinical decisions. This includes recognition of the need to consider results from peripheral blood, aspirated bone marrow and imaging studies, in the context of full clinical details, when assessing bone marrow histology. In different organizational settings, histopathologists or haematologists appropriately take primary responsibility for bone marrow trephine reporting or work conjointly: there is no area of clinical pathology in which an integrated, multidisciplinary approach is more important or rewarding.