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Neoplastic diseases of childhood
  1. ICRF Children’s Cancer Group
  2. St Bartholomew’s Hospital
  3. London EC1A 7BE

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    Editor,—Correspondence provoked by book reviews is unusual, but perhaps opinions there should occasionally be challenged to prevent reviewers shelving their prize without risk of riposte. I write because I was stung by a comment from Mike Stevens in his review of Carl Pochedly’s Neoplastic Diseases of Childhood where he says that ‘...a whole chapter on the “techniques of bone marrow biopsy” seemed a bit over the top’.1 I smart for the obvious reason that I authored the chapter in question, but also because I am disappointed that one of the few unique features of the publication (which, overall, I agree shows its age and does not stand well against its competitors) should be singled out for dismissal.

    Bone marrow aspiration and trephine biopsy is a pivotal investigation in many childhood cancers. It is commonly carried out by paediatric oncologists, frequently by trainees with relatively little experience, and often badly. Training in the procedure is usually little more than the ‘see one, do one, teach one’ approach. While that may work for lumbar punctures or venepunctures where the adequacy or otherwise of the specimen is obvious, it serves less well for a procedure where (arguably) greater skill is needed not only to get a specimen but also to assess its sufficiency and to create fresh smears for microscopy. No amount of subsequent extra effort in the laboratory can compensate for poorly prepared or otherwise inadequate material.

    I have had the privilege of reviewing the diagnostic and early response marrow aspirate smears from children in UK leukaemia trials for some years now and am still struck at the hugely variable quality of the material that passes before my eyes. Libel laws prevent me from saying more than that slides from different centres do show a consistent and considerable variability in quality. It was this, as much as anything, that encouraged me to write the offending chapter when invited to do so. I am not aware that any other textbook for paediatric oncologists has tackled the subject and I remain unrepentant.