Comparison of a powered bone marrow biopsy device with a manual system: results of a prospective randomised controlled trial

The diagnostic and clinical usefulness of a powered bone marrow biopsy device (OnControl()) versus a standard manual device (TRAP Hospital System) was studied. Primary endpoints were biopsy quality and patient pain during the procedure. Fifty patients underwent a total of 60 procedures by three expert operators in a randomised stratified fashion. Baseline demographic and clinical parameters were similar in both groups. The usage of conscious sedation, dosage of lidocaine/pethidin was similar between groups. Biopsy quality was rated ‘sufficient for diagnosis’ in 24/30 in the control group and 25/30 in the powered group (p=0.74). Biopsy cylinder length, procedure time (from skin contact of the biopsy needle to placement of the biopsy cylinder in the formalin container) and patient reported pain during the procedure (T1), 15 min after the procedure (T2) and 3–5 days after the procedure (T3) there were comparable between groups. In the small subgroup of patients that did not receive conscious sedation (n=15; manual 6, powered 9) significantly lower median pain scores were observed with the powered system (median pain score 3 vs 7; p=0.015). Patients were satisfied with either device whether sedation was used (sedation: median 9 for both groups, range 3–10 (manual) and 0–10 (powered)) no sedation (median 8 (manual) vs 9 (powered)). In summary bone marrow biopsies taken with the manual or powered device produce similar technical and clinical results. If no conscious sedation is used, pain during the procedure appears to be lower with the powered system. The use of a powered system seems to be justified in selected patients.

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The Certainty of a Post-Bone Marrow Diagnosis: A Study of the Yield of Bone Marrow Biopsies in a Community Hospital Setting

Blood ◽

10.1182/blood-2020-142032 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 34-35

Author(s):

Manasi M. Godbole ◽

Peter A. Kouides

Keyword(s):

Multiple Myeloma ◽

Bone Marrow ◽

Bone Marrow Biopsy ◽

Fever Of Unknown Origin ◽

Conflicts Of Interest ◽

Diagnostic Yield ◽

Hospital Setting ◽

Unknown Origin ◽

Nutritional Deficiencies ◽

Bone Marrow Biopsies

Introduction: Most studies on the diagnostic yield of bone marrow biopsy including the one by Hot et al. have focused on the yield of bone marrow biopsies in diagnosing the source of fever of unknown origin. However, there have not been any studies performed to our knowledge looking at overall practice patterns and yield of bone marrow biopsies for diagnoses other than fever of unknown origin. We aim to determine the most common indications for performing bone marrow biopsies in a community-based teaching hospital as well as the yield of the biopsies in patients with specified and unspecified pre-test indications to estimate the rate of uncertain post-test diagnoses. Methods: We performed a retrospective data collection study at Rochester General Hospital, NY. A comprehensive search was conducted in our electronic medical data to identify all patients who underwent bone marrow biopsies over a 5 year period from January 2011 - December 2016 for indications other than fever of unknown origin. Patient data including demographics, pre-bone marrow biopsy diagnosis and post-bone marrow diagnosis was obtained. All patients above the age of 18 who underwent bone marrow biopsy for indications other than fever of unknown origin or follow up treatment of a hematological malignancy were included. Results: A total of 223 biopsies were performed. The median age was 59 years (age range- 23-95). One hundred and sixteen patients were male and 107 were female. The most common indications for performing bone marrow biopsy were evaluation of the following possible conditions: multiple myeloma (n=54), myelodysplastic syndrome [MDS] (n=47), lymphoma (n=28) and leukemia (n=18) as well as non-specific indications such as pancytopenia (n=40), anemia (n=22) and thrombocytopenia (n=11). The proportion of cases confirmed by bone marrow biopsy was 45/54 (83%) with the pre-marrow diagnosis of multiple myeloma, 34/47 cases (72%) with the pre-marrow diagnosis of MDS, 15/18 (83%) with the pre-marrow diagnosis of leukemia and 13/28 (46%) in those with the pre-marrow diagnosis of rule out lymphoma. Thirteen cases (18%) with possible MDS had post-bone marrow diagnoses of leukemia, anemia of chronic disease, myelofibrosis or medication-related changes. Five out of twenty two cases (23%) for anemia and 3/11 cases (27%) for thrombocytopenia without otherwise specified pre-bone marrow etiology had uncertain diagnosis after bone marrow biopsy. Conclusion: In about a fifth of patients necessitating a bone marrow, the diagnosis is discordant and can be surprising. It is also worth reporting that in these discordant results, non-hematological causes such as medications, anemia due to chronic diseases or conditions such as cirrhosis or splenomegaly from other etiologies were among the final diagnoses. Interestingly, 20% of the patients with unspecified pre-bone marrow diagnoses such as anemia or thrombocytopenia in our study had an unclear post-bone marrow diagnosis despite undergoing bone marrow biopsy. Our findings are a reminder that the bone marrow exam does not always lead to a definitive diagnosis and the need by exclusion to include in the differential non-hematological etiologies such as nutritional deficiencies, chronic kidney disease or autoimmune disorders. Disclosures No relevant conflicts of interest to declare.

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The Radner Needle a Bone-Marrow Biopsy Device

Scandinavian Journal of Haematology ◽

10.1111/j.1600-0609.1974.tb00209.x ◽

2009 ◽

Vol 12 (4) ◽

pp. 270-273 ◽

Cited By ~ 13

Author(s):

Per Dombernowsky ◽

Anne-Marie Worm ◽

Bo Hainau ◽

Heine H. Hansen ◽

Nis I. Nissen

Keyword(s):

Bone Marrow ◽

Bone Marrow Biopsy ◽

Biopsy Device

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Clinical Relevance of Bone Marrow Biopsy in Staging and Follow-Up of Breast Cancer

Tumori Journal ◽

10.1177/030089168306900210 ◽

1983 ◽

Vol 69 (2) ◽

pp. 143-150 ◽

Cited By ~ 2

Author(s):

Giorgio Cruciani ◽

Gian Maria Fiorentini ◽

Giovanni Rosti ◽

Amelia Tienghi ◽

Daniele Bardella ◽

...

Keyword(s):

Breast Cancer ◽

Bone Marrow ◽

Bone Metastases ◽

Bone Marrow Biopsy ◽

Clinical Relevance ◽

Bone Biopsy ◽

Bone Marrow Biopsies ◽

Female Patients

Bone marrow biopsies by Jamshidi needle were performed in 106 breast cancer female patients. Sixty-four of them were in follow-up after mastectomy, and neoplastic involvement of marrow was found in 21 patients (32.8%). Among the 42 women undergoing staging before mastectomy, the incidence of marrow involvement was 11.9% (5 women, all with radiographic positivity). Of the 37 women, either in follow-up or in the staging phase, with bone metastases detected by roentgenographic and isotopic examination, the bone biopsy was positive in 23 (62.1%), and 7 histologically had micrometastases. Three women, without any radiographic or isotopic sign of metastases, had positive biopsies. A good correlation was found between the hydroxyproline:creatinine ratio and neoplastic involvement of bone marrow.

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Bone Marrow Biopsy Needle Design Influences the Bone Content of Recovered Specimens.

Blood ◽

10.1182/blood.v104.11.5292.5292 ◽

2004 ◽

Vol 104 (11) ◽

pp. 5292-5292

Author(s):

Alec Goldenberg ◽

Priscilla Kelley ◽

Cynthia Liu ◽

Filiz Sen ◽

Sherif Ibrahim

Keyword(s):

Bone Marrow ◽

Bone Marrow Biopsy ◽

Control Group ◽

Computer Assisted ◽

Needle Age ◽

Biopsy Needle ◽

Operator Experience ◽

Patients Âgés ◽

The Mean ◽

Twin Peak

Abstract Introduction: The integrity and composition of bone marrow core biopsies may be influenced by many parameters including patient age, sex, bone density, operator experience, needle selection and biopsy technique. Biopsy needle design impacts on a needle’s performance and the quality of recovered specimens. We studied the effect of modifying the Snarecoil bone marrow biopsy needle tip on the recovery of trabecular bone in core specimens. Methods: 7 patients, ages 35–92, M/F = 4/3, (2 leukemias, 1 lymphoma, 1 cytopenia, 1 anemia, 2 other) underwent a bone marrow biopsy using a 8 gauge Snarecoil needle with a new needle tip (TPNSP). The tip has a twin peak point and more distal Snarecoil position. As a control group, 7 patients biopsied with a standard 8 gauge Snarecoil needle (NTP) were retrospectively identified and matched for age and sex and were ages 37–87, M/F = 5/2, (3 cytopenias, 2 leukemias, 1 lymphoma, 1 other). All biopsies were completed using a minimally manipulative technique from the left posterior superior iliac spine with 2% lidocaine. The length of the specimen and attached clot was measured. The specimens were decalcified for 90 minutes and otherwise processed in the standard fashion. The percentage of bone per core biopsy was determined with computer-assisted morphometry using a BioGenex iVision V3.5 system. Results: The study and control groups were comparable, as the mean age and M/F distribution of the two groups and the mean lengths of the recovered specimens were not statistically significantly different. (TPNSP vs. NTP, 63.8±7.1 vs. 64.7± 6.4 p=0.93, 4/3 vs.5/2 p= 0.57, 2.32± 0.26cm vs. 2.21± 0.26cm p=0.761, respectively). Needle Age M/F Specimen Length % Bone TPNSP 63.8±7.1 4/3 2.32±0.26 (1.2–3.3) 16.3±1.5 (12.1–21.8) NTP 64.7±6.4 5/2 2.21±0.26 (1.3–2.9) 6.8±1.4 (2.9–12.5) However, the mean percentage of bone in the specimens recovered by the new TPNSP needle was greater than that recovered with the NTP needle. (16.3±1.5% vs. 6.8±1.4%, p= 0.0008). Grossly, the TPNSP specimens had a more linear edge than those of the NTP specimens. Also, more (5/7) of the NTP specimens had > 0.5 cm of attached clot then did the TPNSP specimens (0/7), p=0.005 suggesting that the twin peak needle produced less tissue hemorrhage. Conclusions: 1. 8 gauge Snarecoil needles having a sharper tip and more distal Snarecoil recover specimens with as much as 2.5 fold more bone for histopathologic study. 2. The twin peak needle may produce less tissue hemorrhage and disruption.

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A New Rotary Powered Device for Bone Marrow Aspiration and Biopsy Yields Superior Specimens with Less Pain: Results of a Randomized Clinical Study

Blood ◽

10.1182/blood.v116.21.1529.1529 ◽

2010 ◽

Vol 116 (21) ◽

pp. 1529-1529 ◽

Cited By ~ 1

Author(s):

Ronan Swords ◽

Javier Anguita ◽

Russell A. Higgins ◽

Andrea Yunes ◽

Michael Naski ◽

...

Keyword(s):

Bone Marrow ◽

Bone Marrow Biopsy ◽

Research Funding ◽

Bone Marrow Aspiration ◽

Morbidity And Mortality ◽

Procedure Time ◽

Medullary Bone ◽

Biopsy Device ◽

The Mean

Abstract Abstract 1529 Introduction: The importance of bone marrow aspiration and biopsy in the evaluation of hematopoietic and non-hematopoietic disorders is well established. However, this technique is associated with morbidity and mortality risks.1 Recently, a battery-powered bone marrow biopsy system was developed to allow operators to safely, quickly and efficiently access the marrow space. We previously evaluated this device in swine models and in patients needing routine hematology outpatient evaluation.2 In the current study we compared the powered device to the traditional manual technique by relatively assessing pain scores, procedure times, biopsy capture rates, quality of material retrieved, safety and operator satisfaction. Methods: Two large academic medical centers participated in this trial (San Antonio, TX and Madrid, Spain). The study protocol was approved by each center's institutional review board. Adult patients requiring bone marrow biopsies were considered for the study. Following informed consent, patients were randomized to have procedures using a manual biopsy device (T-handle Jamshidi bone marrow biopsy and aspiration set, Cardinal Health, Dublin, OH) or the Powered device (OnControl 11 gauge/102mm Bone Marrow Biopsy System, Vidacare Corporation, Shavano Park, TX). After infiltration of the skin and medullary bone with local anesthesia, a visual analog scale (VAS) pain score was recorded immediately following skin puncture and once again at the end of the procedure for each patient. Procedure time was measured from skin puncture to core specimen ejection from the needle. Pathologic assessment of 30 randomized samples was carried out. Operator satisfaction with devices was measured on a scale of 0–10, with 10 as the highest rating. Statistics were calculated using t-test and chi-square, with an alpha-level of 0.05. Results: Five operators from 2 sites enrolled 50 patients (Powered, n=25; Manual, n=25). Of those patients, 58% were male and 42% were female; and had a mean age of 56.0±18.0 years. The mean height was 167.5 ± 10.5cm and the mean weight was 78.7 ± 22.7kg. Forty percent were lymphoma patients—the largest diagnostic group. Between patient groups, there were no significant differences in the means for these variables. See Table below for quantitative results, including pathology analysis. For the pathology qualitative analysis, there was no difference between groups for hemorrhage, clot/particle spicules, or smear spicules. Conclusions: Results of this trial suggest that the use of a Powered bone marrow biopsy device significantly reduces needle insertion pain. While not reflected in the results, overall pain may be better tolerated due to the important difference in procedure time. Moreover, the superior size and overall quality of core specimens retrieved by the Powered device provides more material for pathologic evaluation, thereby increasing diagnostic yield and reducing the need for repeat procedures. Cohesiveness of the medullary bone sampled was comparable for both techniques; however, the Powered system was less likely to recover non-hematopoietic tissue (e.g. cortical bone and soft tissue). Artifact was slightly more common with the Powered device (aspiration, hemorrhage and crush) but this did not impact on the diagnostic quality of the sample. No differences in safety data were noted for either technique and operator satisfaction favored the Powered device. 1. Bain BJ. Bone marrow biopsy morbidity and mortality. British Journal of Haematology 2003;121:949-51. 2. Swords RT, Kelly KR, Cohen SC et al. Rotary powered device for bone marrow aspiration and biopsy yields excellent specimens quickly and efficiently. J Clin Pathol 2010;63:562-5. Disclosures: Swords: Vidacare Corporation: Research Funding. Anguita:Vidacare Corporation: Research Funding. Kelly:Vidacare Corporation: Research Funding. Philbeck:Vidacare Corporation: Employment. Miller:Vidacare Corporation: Employment, Equity Ownership. Brenner:Vidacare Corporation: Research Funding.

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Bone Effect of Botezomib in Patients with Relapse and Smoldering Myeloma; A Computer Assisted Image Analysis Study of Bone Marrow Core Biopsies,

Blood ◽

10.1182/blood.v118.21.3996.3996 ◽

2011 ◽

Vol 118 (21) ◽

pp. 3996-3996

Author(s):

Mohamed E Salama ◽

Graham E. Wagner ◽

Tamara Berno ◽

Jessica Kohan ◽

Fenghuang Zhan ◽

...

Keyword(s):

Multiple Myeloma ◽

Bone Marrow ◽

Image Analysis ◽

Bone Marrow Biopsy ◽

Computer Assisted ◽

Weekly Dose ◽

Bone Marrow Biopsies ◽

Bortezomib Treatment ◽

Smoldering Myeloma ◽

Bone Effect

Abstract Abstract 3996 Background: Bone loss and related complications including bone pains, fractures and hypercalcemia are major causes of morbidity and mortality in multiple myeloma (MM) patients. Bone growth/loss (Bone mineral densitometry) can be monitored by dual x-ray absorptiometry (DXA) in patients with smoldering myeloma (SMM). We previously reported a novel quantitative method to asses trabecular volume (TV) using whole scanned slides and image analysis (WSI) obtained from bone marrow biopsy (Teman et al. 2010). This method provides a low cost reproducible mean to assess TV in archival paraffin embedded biopsy materials. Velcade has been shown to produce an anabolic bone effect in relapsed/refractory MM patients and in this study, we examine the effect of low-dose bortezomib (Velcade) in SMM patients using the WSI methodology. Methods: Bone marrow biopsy slides obtained before, during and after bortezomib treatment were used to evaluate TV. H&E stained core biopsy slides were scanned using Scan Scope XT system (Aperio Technologies, Vista, CA) into digital whole slide images that is viewable on Aperio Image Scope. We developed classifier algorithms using Genie (Aperio) pattern recognition image analysis software (PRIA) that were adept at identifying bone, hematopoietic tissue, and clear glass. The calculated bone area (TV) was represented as a ratio of the total hematopoietic area for each biopsy event. Slides were excluded if the analysis available area was less than 6mm2 or could not be classified correctly to the satisfaction of the pathologist Mixed-effects models were used to compare bone TV/hematopoietic ratios (HR) over time and between the different groups, as well as assess any correlation with that ratio and light chain, B-2-microglobulin, and plasma cell levels. Results were considered statistically significant if p<0.05. Results: Slides from 253 consecutive biopsies composed the study materials. 45 were excluded due to significant artifacts or small analysis areas (<6mm2). 208 bone marrow biopsies from 43 patients were included in the analysis. The group included 26 maintenance, 12 relapsed, and 5 smoldering patients; The relapsed and maintenance patients received Bortezomib alone or in combination for a minimum of three cycles; smoldering patients received bortezomib as part of a phase 2 study at the weekly dose of 0.7mg/kg. All maintenance and relapsed, patients had previously received bone marrow transplant with a median 68 years of age 29 were male. Median baseline TV/HR was 32.9%for maintenance 29.8% for relapse and 33.1% smoldering groups. A median increment of TV/RH (17%) was observed after Bortezomib treatment in all groups of patients (p<0.0001). Conclusion: Analysis of bone associated changes after Bortezomib exposure in patients with multiple myeloma by Scan Scope XT demonstrate a post treatment overall gain in bone formation. Monitoring bone indices in patients with multiple myeloma with PRIA may provide a valid tool to assess treatment associated bone effect. Disclosures: No relevant conflicts of interest to declare.

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N-Cadherin Immunoexpression In Patients With Acute Myeloid Leukemia

Blood ◽

10.1182/blood.v122.21.4976.4976 ◽

2013 ◽

Vol 122 (21) ◽

pp. 4976-4976

Author(s):

Rahul D Pawar ◽

Tara L. Lin ◽

Wei Cui ◽

Omar S. Aljitawi

Keyword(s):

Bone Marrow ◽

Bone Marrow Biopsy ◽

Myeloid Leukemia ◽

Statistical Difference ◽

Culture Conditions ◽

Bone Marrow Biopsies ◽

Biopsy Specimens ◽

Control Bone ◽

Grade 3 ◽

Acute Myeloid

Abstract Introduction N-cadherin is a member of the cadherin family which is involved in calcium ion dependent adhesion between cells by interaction with catenin on other cells. In our previous work, we have shown differential patterns of N-cadherin expression in acute myeloid leukemia (AML) cell lines when cultured in traditional 2-dimensional (2-D) culture conditions (over monolayer of stromal cells) compared to 3-D culture conditions. In addition, we have observed that AML cell lines which are more resistant to chemotherapy in vitro had higher expression of N-cadherin, suggesting potential translational applications to patients with AML. In order to further examine the role of N-cadherin in AML, we studied patterns of N-cadherin immunoexpression in bone marrow samples taken from patients with untreated AML and compared them to control bone marrow samples. Methods In this retrospective study, we evaluated bone marrow biopsy specimens of 10 AML patients for N-cadherin expression by immunohistochemistry. Bone marrow biopsy specimens from 10 negative staging lymphoma patients were used as control. Automated Cellular Imaging system (ACIS) was used to quantify and grade N-cadherin immunoexpression in the nucleus as well as in the cytoplasm of evaluated cells. ACIS uses advanced color detection software in order to evaluate N-cadherin positive cells and measure the intensity of staining. Grades of N-cadherin positivity were subclassified as grade 0 (no staining) 1+, 2+, 3+. 10 different areas of each sample were evaluated in order to estimate the median intensity of staining per slide. Student’s t-test was used to compare the generated medians and a P-value of <0.05 was considered statistically significant. Results Nuclear N-cadherin staining was graded and compared between bone marrow biopsy specimens of patients with AML and control bone marrow biopsies from patients with negative staging bone marrow examinations for lymphoma. Interestingly, the percentage of N-cadherin grade 0 (negative) cells was higher in controls than AML samples (54% vs. 37%, p=0. 01). Also, the percentage of grade 1 and grade 2 expressing cells was significantly higher in AML cases compared to controls (grade 1: 39% vs. 29%, p=0.005; grade 2: 21% vs. 13%, p=0.029). However, there was no statistical difference seen in between AML cases and controls in terms of levels of grade 3 expression. Similarly, cytoplasmic N-cadherin staining was quantified. Grade 0 expressing cells were significantly higher in control samples compared to AML samples (34% vs. 16%, p=0.01). There was no statistical difference seen in terms of levels of grade 1 expression. However, grade 2 and 3 expression levels quantifying the higher levels of N-cadherin expression were significantly higher in bone marrow biopsies from patients with AML versus those from negative staging bone marrows (grade 2: 26% vs. 9%, P=0.01; grade 3: 4% vs. 1%, p=0.04). Conclusion Based on these results, we conclude that cytoplasmic N-cadherin expression is significantly increased in AML bone-marrow samples compared to control samples. These results should be further evaluated in the future to determine the prognostic significance of N-cadherin expression in AML. Disclosures: No relevant conflicts of interest to declare.

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Do patients with MGUS require a bone marrow biopsy?

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.8117 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 8117-8117

Author(s):

J. Singh ◽

A. K. Malani ◽

C. H. Huang ◽

M. Hashmi ◽

S. C. Mathur ◽

...

Keyword(s):

Bone Marrow ◽

Regression Analysis ◽

Bone Marrow Biopsy ◽

Plasma Cell ◽

Linear Correlation ◽

Plasma Cells ◽

Bone Marrow Biopsies ◽

Cell Percentage ◽

Serum Igg ◽

Immunoglobulin Levels

8117 Monoclonal gammopathy of undetermined significance (MGUS) increase in prevalence with age and it is associated with risk of progression to plasma cell disorder. According to ASH guidelines, patients (pts) should have a complete blood count (CBC), creatinine, calcium, and a complete bone survey and periodic follow up. There has been no clear-cut guideline regarding the role of bone marrow biopsy in these patients. There is suggestion in the literature that bone marrow aspiration and biopsy is indicated if the M protein is 1.5 g/dL. Hypothesis We hypothesize that the increase in serum immunoglobulin is correlated with an increase in plasma cell in the bone marrow biopsy. Methods: We performed a retrospective chart review of 327 MGUS veteran patients seen from 2002 to 2005. Diagnostic criteria for MGUS were defined as <3 g/dL serum monoclonal protein, <10 % plasma cells in the bone marrow and absence of radiographic or laboratory abnormality related to the plasma cell proliferative process. Patients with smoldering myeloma were excluded. Bone marrow biopsies were available on 97/327 patients. Bone marrow biopsy with plasma cell percentage, serum protein electrophoresis (SPEP) and immunofixation (SFE), and immunoglobulin levels of these patients were retrieved and statistical analysis was performed by using Pearson correlation coefficient and linear regression analysis to detect the correlation between plasma cell percentage and immunoglobulin levels. Results: Of the 97 patients whom the bone marrow biopsy was available, 66 patients had IgG, 15 had IgA and 16 had IgM monoclonal paraprotein. There was linear correlation between serum IgG and IgA levels with the percentage of plasma cells in the bone marrow. (p< 0.001 and < 0.02 respectively. By regression analysis, using a cut off value of 10% plasma cells in the bone marrow, the predicted level of IgG and IgA immunoglobulin was 2124 mg /dl and 1564 mg/dl respectively. There was no correlation between IgM immunoglobulin and plasma cell percentage in the marrow. Conclusion: There is a linear correlation between serum IgG and IgA immunoglobulin with plasma cell percentage in the bone marrow. Bone marrow biopsy with plasma cell percentage of 10% or higher may be predicted in patients with MGUS with IgG or IGA above 2g/dl and 1.5g/dl respectively. No significant financial relationships to disclose.

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Significance of Bone Marrow Plasma Cell Percentage in Patients with Monoclonal Gammopathy of Unknown Significance Developing Multiple Myeloma

Blood ◽

10.1182/blood.v124.21.5688.5688 ◽

2014 ◽

Vol 124 (21) ◽

pp. 5688-5688

Author(s):

Mona L Vekaria ◽

Bharat Rao ◽

Philip Kuriakose

Keyword(s):

Risk Factors ◽

Bone Marrow ◽

Bone Marrow Biopsy ◽

Plasma Cell ◽

Monoclonal Gammopathy ◽

Plasma Cells ◽

Time To Progression ◽

Bone Marrow Biopsies ◽

Monoclonal Protein ◽

Cell Percentage

Abstract Introduction: Monoclonal gammopathies are characterized by the detection of a monoclonal immunoglobulin in the serum or urine and underlying proliferation of a plasma cell/B lymphoid clone. (1) Patients with monoclonal gammopathy of undetermined significance (MGUS) have a clonal plasma cell population in the marrow (<10%) and secrete a monoclonal protein in the serum (<3g/dL) and/or urine. However, they lack clinical features of overt Multiple Myeloma (MM) (lytic bone lesions, anemia, renal impairment and hypercalcemia). In a study from the Mayo Clinic, 59 of 241 patients with MGUS (24%) developed MM over a period of 22 years. (2) The interval from recognition of monoclonal protein to diagnosis of MM ranged from 2-29 years, indicating that patients with MGUS need to be followed indefinitely. Many risk factors have been looked at to identify those with MGUS who are at the highest risk to progress into MM. We hypothesize that a higher number of plasma cells would correlate with a greater risk of progression to MM and sought to find out if this could be documented by arbitrarily dividing patients between < or ≥5% plasma cells seen on initial bone marrow biopsy. Methods: We retrospectively reviewed patients diagnosed with MGUS at Henry Ford Hospital between 1999-2013 who underwent a bone marrow biopsy for documenting plasma cell percentage. In addition to this, we also recorded serum hemoglobin, calcium, creatinine, monoclonal protein type and amount, serum free light chains, beta-2 microglobulin and urine for monoclonal protein at the time of diagnosis of MGUS as well as last completed values. For patients that had skeletal surveys we noted if lytic lesions were present at diagnosis, as well as cytogenetics and karyotype evaluations on bone marrow biopsy samples, if completed. Results: 120 patients with bone marrow biopsies were reviewed. Out of this 17 patients were noted from initial bone marrow biopsy to have ≥10% plasma cells. The remaining 103 patients were categorized as having MGUS. While we were not able to complete full statistical analyses, we did note that 14 of these 103 (13.6%) patients went on to develop overt MM. Further evaluation of these patients revealed that 8 of 14 (57%) had bone marrow biopsies showing ≥5% plasma cells. Interestingly the average time to progression into MM in this subgroup was 1,879 days whereas in the 6 of 14 (43%) with bone marrow biopsy showing <5% plasma cells had average time to progression into MM of 1,965 days. Abnormal cytogenetics and karyotypes of the bone marrow biopsy were also seen in 37.5% of the subgroup of patients with ≥5% plasma cells whereas it was only seen in 16.7% of the subgroup of patients with <5% plasma cells. With statistical data analyses we hope to prove significance in the above collected data as well as make further correlations in regards to risk factors in patients with MGUS. Conclusion: While we have not been able to complete full statistical analyses of the collected data yet, basic review of the above patients with MGUS and ≥5% plasma cells in the bone marrow biopsy showed a trend to develop MM faster by an average of 86 days than those that had <5% plasma cells. These same patients also were more likely to have abnormal cytogenetics and karyotypes of their bone marrow biopsies. There is a need for further investigations to be done in patients with MGUS and higher risk features. It is important that hematologists be able to recognize a high risk MGUS patient as this would lead to closer monitoring and consideration for earlier aggressive treatment to potentially delay progression into overt MM. Disclosures No relevant conflicts of interest to declare.

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A Prospective Comparison of Bone Marrow Biopsy Adequacy with and without Use of Powered Assistive Drill in the Clinical Setting Versus Interventional Radiology

Blood ◽

10.1182/blood.v124.21.4823.4823 ◽

2014 ◽

Vol 124 (21) ◽

pp. 4823-4823

Author(s):

Tara T. Barnett ◽

Jana M. Reynolds ◽

Andrew Shakespeare ◽

Paul Dye ◽

Edward S. Rappaport ◽

...

Keyword(s):

Bone Marrow ◽

Interventional Radiology ◽

Bone Marrow Biopsy ◽

Clinical Setting ◽

Tertiary Care ◽

Bone Marrow Biopsies ◽

Ct Guided ◽

Clinical Site ◽

The Mean ◽

The Impact

Abstract Background The adequacy of bone marrow biopsies is most often defined by trephine length. By this definition, adequacy has been associated with the experience of the procedure operator. In small prospective studies, powered assistive drills have also affected adequacy as their use has been shown to yield longer trephine lengths as compared to manual devices. Within our Central Texas academic institution tertiary care center, we have noted the two following recent changes in our bone marrow biopsy practice: routine implementation of the powered assistive drill and the use of interventional radiology for CT-guided bone marrow biopsies of more difficult patients (i.e. obese body habitus, altered anatomy, previous failed attempts, etc.), and those who desire sedation. This study aims to review the impact of powered assistive drill use and referral to interventional radiology on the adequacy of bone marrow biopsies at our institution. Methods Consecutive bone marrow biopsies performed at the Baylor Scott & White Health clinical site 1 (CS1), one of the satellite clinics (CS2), and interventional radiology (IR) from January 1, 2011, through December 31, 2013, were eligible for inclusion. Patients less than 18 years of age were excluded. A prospective registry recorded the date of procedure, patient medical record number, patient age, as well as the presence of spicules within the aspirate (yes or no), and trephine length (in mm) determined by pathology. Procedure location and use of the powered assistive drill for each procedure were determined by billing codes. Trephine length was compared between locations and by use of the assistive drill with Wilcoxon two-sample tests. Results In total, 888 bone marrow biopsies were performed. 753 were performed in the clinical setting (554 at CS1 and 199 at CS2), and 135 in IR. Overall, 326 biopsies utilized the powered drill and 562 were performed manually. Mean trephine length, independent of assistive drill use, was 10.1 mm, 10.3 mm, and 7.4 mm at CS1, CS2, and IR locations respectively; with a significantly shorter trephine length observed in IR as compared to CS1 (p < 0.0001), and CS2 (p <0.0001). The mean trephine length of biopsies obtained with use of the assistive drill was significantly longer than those performed manually at CS1 (10.8 mm vs 9.3 mm [p = 0.0004]), and in IR (10.6mm vs 5.9 mm [p <0.0001]), respectively. There was no difference in mean trephine length between CS1 and IR with use of the drill (10.8 mm and 10.6 mm [p = 0.8123]). The presence of spicules did not differ with the use of the assistive drill at either location (p = 0.9463). CS2 has not yet implemented the routine use of the powered assistive drill. Discussion A statistically significant increase in mean trephine length was observed with use of the assistive drill between CS1 and IR, though the only difference of clinical significance was that observed in IR. With use of the drill, however, the mean trephine lengths between our clinical site and interventional radiology was no longer statistically significant. The use of the assistive drill in IR simply increased trephine length to equal those obtained routinely in the clinical setting. This suggests the use of powered assistive devices, in a patient population for whom CT-guidance is necessary, may increase the likelihood of obtaining a trephine of similar adequacy to those performed on the “ideal” patient at the bedside by experienced operators. Disclosures No relevant conflicts of interest to declare.

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