Bone marrow tests: The bone marrow is sampled by a technique known as bone marrow aspiration. During this procedure, a thin, hollow needle with a syringe attachment is used to suction up (aspirate) a teaspoon-sized sample of liquid bone marrow from the back of the hip bone. A larger needle is then employed to obtain a bone marrow biopsy ("core" biopsy), which removes roughly a 1/16 inch cylindrical piece of bone marrow from the hip site. After the bone marrow samples are obtained, they are examined by many physician specialists, including a pathologist (disease diagnosis specialist, who examines samples under a microscope), hematologist (blood specialist), and oncologist (cancer specialist). The individual is generally awake during the procedure, but local anesthetics (such as lidocaine) and sedatives (such as midazolam or Versed®) may be administered. There is usually no pain involved.
Cytogenetic analysis: Cytogenetic analysis detects changes in the chromosomes, including the presence of the Philadelphia chromosome (a genetic abnormality that can lead to leukemia). It can be done using a regular microscope or a more modern lab technology called fluorescence in situ hybridization (FISH). Blood will be drawn from the individual and analyzed for the genetic abnormality.
X-ray: X-rays are used to see whether there are enlarged lymph nodes in the chest, localized masses in the lungs, or evidence of spreading to the outer bones or joints.
Magnetic resonance imaging (MRI): Magnetic resonance imaging (MRI) scan is a procedure that uses electromagnets and radio waves to create computer-generated pictures of the internal organs. MRI may be used if the doctor suspects that leukemia involves the brain or lungs.
Radionuclide scan: A radionuclide scan may be performed to rule out non-leukemic disorders in individuals who complain of bone pain. The radiologist injects the individual with a radioactive chemical (such as gallium-67), which will accumulate in areas of infection or malignancy and can be viewed with a special camera. This procedure is not used for individuals who already have been diagnosed with leukemia.
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