Improving the quality of bone marrow assessment

Abstract

BACKGROUND: Successful bone marrow assessment is essential to the diagnosis and staging of hematologic malignancies. The objective of this study was to determine whether specific operator techniques and/or use of a specimen preparation checklist could impact the quality of bone marrow assessment by reducing the frequency of nonspicular aspirates, small cores, and nondiagnostic samples. METHODS: All bone marrow biopsies performed at the Dana-Farber Cancer Institute from April, 2012 to September, 2012 were eligible for inclusion. Six operator techniques were linked with specimen quality in a preintervention cohort. Next, a specimen preparation checklist was implemented, and outcomes were compared from the preintervention and postintervention cohorts. RESULTS: In total, 830 procedures performed by 41 operators were prospectively observed and analyzed. In the preintervention cohort (n 5 413), no operator technique was associated with specimen quality in multivariable models accounting for patient characteristics and operator. Compared with the preintervention cohort, in multivariable analyses, the postintervention cohort (n 5 417) had decreased odds of nondiagnostic specimens (odds ratio, 0.49; 95% confidence interval, 0.28-0.87; P 5.01) and core lengths 1 cm (odds ratio, 0.67; 95% confidence interval, 0.50-0.90; P 5.009), but there was no significant difference in spicularity. CONCLUSIONS: Variation in the operator techniques studied did not have an impact on specimen quality, but implementation of a specimen preparation checklist significantly improved core length and frequency of diagnostic samples. Cancer 2013;119:3472-8.

Bone Marrow Aspiration: A Randomized Controlled Trial Assessing the Quality of Bone Marrow Specimens Using Slow and Rapid Aspiration Techniques and Evaluating Pain Intensity

“…Textbooks and BMA guidelines rarely mention the aspiration technique, and when they do, rapid aspiration is mentioned [2,3,4]. Former studies have examined the impact that biopsy devices, operator profession and experience have on the quality of bone marrow (BM) assessment and pain [1,5,6,7,8,9,10]. To our knowledge, studies on the aspiration technique and its association with specimen quality are sparse.…”

“…Obtaining the optimal quality of the specimen for pathologic review is obviously important [1]. Textbooks and BMA guidelines rarely mention the aspiration technique, and when they do, rapid aspiration is mentioned [2,3,4].…”

Prevalence of massively diluted bone marrow cell samples aspirated from patients with myelodysplastic syndromes (MDS) or suspected of MDS: A retrospective analysis of nationwide samples in Japan

“…Checklists covering vital points in BM sampling are useful for reminding these personnel of the points before sampling, for assistants to inform operators of the estimation of collected samples during sampling, and for providing feedback about the quality of samples to these personnel from laboratories later. 11,20 Although such checklists can help improve and generalise required knowledge, technical aspects need effective and practical training. In this regard, training for nurse practitioners and doctors supervised by wellexperienced experts is strongly recommended.…”

“…In these studies, BM cells were aspirated from patients with various diseases, without focusing on MDS, at a single hospital (or a hospital group in one study), and it was reported that approximately 20%-30% of the aspirated BM samples were massively haemodiluted. [11][12][13] Here, we report the first study to examine the incidence of massive haemodilution in nationwide BM samples aspirated from patients who were diagnosed with or suspected of having MDS in Japan.…”

Does Needle Design Affect the Regenerative Potential of Bone Marrow Aspirate? An In Vitro Study

“…Furthermore, several studies have shown that there is a clear correlation between sample quality, surgeon experience, technique and needle [ 35 , 44 , 45 ]. Since the number of MSCs decreases when aspiration is repeated at the same location, it is recommended that the location of harvesting should be changed at least after every third puncture in order to obtain the highest possible yield of MSCs [ 35 ].…”