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

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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Safety and Technical Success of CT-Guided Bone Marrow Biopsy in Obese Patients

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0039-3401330 ◽

2020 ◽

Vol 4 (01) ◽

pp. 16-19

Author(s):

Barbara Manchec ◽

Joseph Limback ◽

Bo Liu ◽

Julie W Pepe ◽

Jeremy Burt ◽

...

Keyword(s):

Bone Marrow ◽

Bone Marrow Biopsy ◽

High Rate ◽

Hemorrhagic Complication ◽

Complication Rates ◽

Obese Patients ◽

Technical Success ◽

Bone Marrow Biopsies ◽

Ct Guided ◽

Grade 3

Abstract Purpose Obesity can make bone marrow biopsy using manual landmarks as guidance technically challenging. This retrospective review was performed to assess the safety and technical success of performing bone marrow biopsies with computed tomography (CT)–guidance in obese patients. Materials and Methods This single-institution, retrospective study included 1,016 CT-guided bone marrow biopsies performed between 2009 and 2016. Thirty-four percent (n = 348) were performed in patients with a body mass index (BMI) of 30 kg/m2 or greater, and 7% (n = 75) were performed in patients with a BMI greater than 40 kg/m2. Demographic information, BMI, and complications were reviewed. The primary endpoint was technical success and procedurally related hemorrhagic complication. The electronic medical record was reviewed to identify procedural related hemorrhagic complications, Common Terminology Criteria for Adverse Events (CTCAE) Grade 3 or above. The complication rates in obese patients were compared with patients with a BMI less than 30 kg/m2. Results Biopsy was successfully performed in all patients. No biopsies resulted in a CTCAE Grade 3 or above complication. There was no difference in complication rate (0%) based on BMI. For patients with a BMI < 30 kg/m2, BMI ≥ 30 kg/m2, and BMI > 40 kg/m2, complications rates were 0% (95% confidence interval [CI]: 0–0.4%), 0% (95% CI: 0–0.9%), and 0% (95% CI: 0–4%), respectively. Conclusions CT-guided bone marrow biopsy in obese patients can be performed with a high rate of technical success and is safe. If patient body habitus limits the ability to palpate physical landmarks needed to perform bone marrow biopsy without image guidance, CT-guided bone marrow biopsy should be considered.

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Management of the Procedural Pain Induced by Bone Marrow Biopsies: An Observational Study

Annals of Clinical Oncology ◽

10.31487/j.aco.2020.01.06 ◽

2020 ◽

pp. 1-5

Author(s):

Marilene Filbet ◽

Audrey Fawoubo ◽

Colombe Tricou ◽

Elise Perceau-Chambard ◽

Guillaume Economos ◽

...

Keyword(s):

Bone Marrow ◽

Observational Study ◽

Local Anesthesia ◽

Bone Marrow Biopsy ◽

Tertiary Hospital ◽

Mitigation Strategies ◽

Procedural Pain ◽

Bone Marrow Biopsies ◽

Pain Experience ◽

The Mean

Introduction: Bone marrow biopsy is an investigation procedure in hematology which might lead to procedural pain. Therefore, our study aimed to assess procedural pain intensity and to identify factors associated with pain experience. Methods: We performed an observational study of consecutive patients who underwent a bone marrow biopsy in a tertiary hospital hematology ward. The pain was assessed using a visual analogue scale (0-100 mm) before, during and after the procedure. We also collected data as premedication strategy, anxiety, physician’s experience and the experience of a previous biopsy. Results: Forty consecutive patients were recruited. The biopsies were mostly performed for diagnostic purposes (45%). Thirty percent had local anesthesia alone and 70% had local anesthesia plus any other medication. The mean pain before the procedure was 9mm (SD=1.7), during 36mm (SD=2.7) and after 9.5mm (SD=1.0). No statistical difference has been shown between the different pain prophylaxis (p=0.622). The level of anxiety before the procedure was significantly correlated with the procedural pain experienced (r2=0.323, p=0.042), while the length of the procedure and previous experience of the procedure were not. Conclusion: This study suggests that bone marrow procedural pain can be improved and highlights several promising mitigation-strategies to address this issue.

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The Impact of Obesity on the Management and Outcomes of Postpartum Hemorrhage

American Journal of Perinatology ◽

10.1055/s-0040-1718574 ◽

2020 ◽

Author(s):

Aleksandra Polic ◽

Tierra L. Curry ◽

Judette M. Louis

Keyword(s):

Interventional Radiology ◽

Blood Transfusion ◽

Blood Loss ◽

Postpartum Hemorrhage ◽

Tertiary Care ◽

P Value ◽

Obese Women ◽

Severe Morbidity ◽

The Impact ◽

To Receive

Objective The study aimed to evaluate the impact of obesity on the management and outcomes of postpartum hemorrhage. Study Design We conducted a retrospective cohort study of women who delivered at a tertiary care center between February 1, 2013 and January 31, 2014 and experienced a postpartum hemorrhage. Charts were reviewed for clinical and sociodemographic data, and women were excluded if the medical record was incomplete. Hemorrhage-related severe morbidity indicators included blood transfusion, shock, renal failure, transfusion-related lung injury, cardiac arrest, and use of interventional radiology procedures. Obese (body mass index [BMI] ≥ 30 kg/m2) and nonobese women were compared. Data were analyzed using Chi-square, Student's t-test, Mann–Whitney U test, and linear regression where appropriate. The p-value <0.05 was significant. Results Of 9,890 deliveries, 2.6% (n = 262) were complicated by hemorrhage. Obese women were more likely to deliver by cesarean section (55.5 vs. 39.8%, p = 0.016), undergo a cesarean after labor (31.1 vs. 12.2%, p = 0.001), and have a higher quantitative blood loss (1,313 vs. 1,056 mL, p = 0.003). Both groups were equally likely to receive carboprost, methylergonovine, and misoprostol, but obese women were more likely to receive any uterotonic agent (95.7 vs. 88.9%, p = 0.007) and be moved to the operating room (32.3 vs. 20.4, p = 0.04). There was no difference in the use of intrauterine pressure balloon tamponade, interventional radiology, or decision to proceed with hysterectomy. The two groups were similar in time to stabilization. There was no difference in the need for blood transfusion. Obese women required more units of blood transfused (2.2 ± 2 vs. 2 ± 5 units, p = 0.023), were more likely to have any hemorrhage-related severe morbidity (34.1 vs. 25%, p = 0.016), and more than one hemorrhage related morbidity (17.1 vs. 7.9, p = 0.02). After controlling for confounding variables, quantitative blood loss, and not BMI was predictive of the need for transfusion. Conclusion Despite similar management, obese women were more likely to have severe morbidity and need more units of blood transfused. Key Points

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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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P139: The impact of a pancreatitis admission algorithm on emergency department length of stay in a tertiary care academic hospital

CJEM ◽

10.1017/cem.2020.343 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S114-S115

Author(s):

A. Albina ◽

F. Kegel ◽

F. Dankoff ◽

G. Clark

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Tertiary Care ◽

Physician Satisfaction ◽

Academic Hospital ◽

Before And After ◽

Potential Applicability ◽

The Mean ◽

Algorithm Implementation ◽

The Impact

Background: Emergency department (ED) overcrowding is associated with a broad spectrum of poor medical outcomes, including medical errors, mortality, higher rates of leaving without being seen, and reduced patient and physician satisfaction. The largest contributor to overcrowding is access block – the inability of admitted patients to access in-patient beds from the ED. One component to addressing access block involves streamlining the decision process to rapidly determine which hospital service will admit the patient. Aim Statement: As of Sep 2011, admission algorithms at our institution were supported and formalised. The pancreatitis algorithm clarified whether general surgery or internal medicine would admit ED patients with pancreatitis. We hypothesize that this prior uncertainty delayed the admission decision and prolonged ED length of stay (LOS) for patients with pancreatitis. Our project evaluates whether implementing a pancreatitis admission algorithm at our institution reduced ED time to disposition (TTD) and LOS. Measures & Design: A retrospective review was conducted in a tertiary care academic hospital in Montreal for all adult ED patients diagnosed with pancreatitis from Apr 2010 to Mar 2014. The data was used to plot separate run charts for ED TTD and LOS. Serial measurements of each outcome were used to monitor change and evaluate for special cause variation. The mean ED LOS and TTD before and after algorithm implementation were also compared using the Student's t test. Evaluation/Results: Over four years, a total of 365 ED patients were diagnosed with pancreatitis and 287 (79%) were admitted. The mean ED LOS for patients with pancreatitis decreased following the implementation of an admission algorithm (1616 vs. 1418 mins, p = 0.05). The mean ED TTD was also reduced (1171 vs. 899 mins, p = 0.0006). A non-random signal of change was suggested by a shift above the median prior to algorithm implementation and one below the median following. Discussion/Impact: This project demonstrates that in a busy tertiary care academic hospital, an admission algorithm helped reduce ED TTD and LOS for patients with pancreatitis. This proves especially valuable when considering the potential applicability of such algorithms to other disease processes, such as gastrointestinal bleeding and congestive heart failure, among others. Future studies demonstrating this external applicability, and the impact of such decision algorithms on physician decision fatigue and within non-academic institutions, proves warranted.

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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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Polysomnography Outcomes after Supraglottoplasty in Children with Obstructive Sleep Apnea

Otolaryngology ◽

10.1177/0194599819844512 ◽

2019 ◽

Vol 161 (4) ◽

pp. 694-698 ◽

Cited By ~ 3

Author(s):

Bharat Bhushan ◽

James W. Schroeder ◽

Kathleen R. Billings ◽

Nicholas Giancola ◽

Dana M. Thompson

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Tertiary Care ◽

Case Series ◽

Apnea Hypopnea Index ◽

Historical Cohort ◽

Tertiary Care Medical Center ◽

Obstructive Sleep ◽

The Mean ◽

The Impact

ObjectiveLaryngomalacia has been reported to contribute to the severity of obstructive sleep apnea (OSA) in children. It is unclear if surgical treatment of laryngomalacia improves polysomnography (PSG) outcomes in these patients. The objective of this study is to report the impact of supraglottoplasty on PSG parameters in children with laryngomalacia-related OSA.Study DesignRetrospective case series.SettingTertiary care medical center.Subjects and MethodsHistorical cohort study of consecutive children with laryngomalacia who underwent supraglottoplasty and who had undergone overnight PSG before and after surgery.ResultsForty-one patients were included in the final analysis: 22 (53.6%) were male, and 19 (46.3%) were female. The mean ± SEM age of patients at preoperative PSG was 1.3 ± 0.89 years (range, 0.003-2.9). In entire cohort, the mean obstructive apnea-hypopnea index score was reduced from 26.6 events/h before supraglottoplasty to 7.3 events/h after surgery ( P = .003). Respiratory disturbance index was reduced from 27.3 events/h before supraglottoplasty to 7.8 events/h after surgery ( P = .003). The percentage of REM sleep decreased from 30.1% ± 2.4 to 24.8% ± 1.3 ( P = .04). Sleep efficiency was improved ( P = .05).ConclusionOverall, supraglottoplasty significantly improved several PSG outcomes in children with laryngomalacia. However, mild to moderate OSA was still present postoperatively in most children. This suggested a multifactorial cause for OSA in this population.

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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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Influence of Age and Needle Gauge on Bone Marrow Biopsy Specimen Adequacy.

Blood ◽

10.1182/blood.v106.11.5581.5581 ◽

2005 ◽

Vol 106 (11) ◽

pp. 5581-5581

Author(s):

Alec Goldenberg ◽

Priscilla Kelley ◽

Sherif Ibrahim ◽

Filiz Sen ◽

Cynthia Liu

Keyword(s):

Bone Marrow ◽

Bone Marrow Biopsy ◽

Older Patients ◽

Response To Treatment ◽

Specimen Length ◽

Younger Patients ◽

Biopsy Specimens ◽

Clinical Diagnoses ◽

The Mean ◽

Biopsy Needles

Abstract Introduction. The quality and length of bone marrow biopsy core specimens should facilitate accurate diagnositic interpretation of marrow histopathology. A 11G specimen of length 1.6 cm or greater is considered adequate for pathologic evaluation by some authors. The length of specimens recovered with 11G needles appears to depend on needle design. We explored the possibility that the adequacy of bone marrow biopsy specimens may be influenced by patient age and the gauge of biopsy needles. Methods. 88 bone marrow core specimens were recovered from 72 patients using 11G SNARECOIL bone marrow biopsy needles. The mean age of these patients was 61.4 and the m/f ratio was 45/27. The clinical diagnoses were isolated anemia, cytopenias, leukemia, lymphoma, myeloma and other in 18.0%, 33.3%, 13.8%, 13.8%, 5.5% and 15.2% of the patients, respectively. 10 patients underwent multiple procedures (2–6) for evaluation of treatment efficacy. 106 patients underwent 127 bone marrow biopsy procedures using 8G SNARECOIL needles. The m/f ratio was 56/50 and the mean age of the patients was 63.1years. The clinical diagnoses were isolated anemia, cytopenia, leukemia, lymphoma, myeloma or other in 22.2%, 19.6%, 14.9%, 21.2%, 12.5% and 9.4% patients respectively. 13 patients underwent multiple procedures (range 2–4) for evaluation of response to treatment. Results. Although the mean length of the 11G and 8G specimens were statistically significantly the same (mean±SEM, 1.97±0.07 cm vs. 1.99±0.05 cm, respectively, p = 0.8), the distribution of specimen lengths was asymmetric or skewed for the 11G specimens (skewness(skw) =0.52) and nearly normal for the 8G specimens (skw =0.04). The deviation from a normal distribution suggested additional variable(s) might be effecting specimen length. The possible influence of age on specimen length relative to needle gauge was considered. The mean age of the patients biopsied with 11G needles was 61.4. The m/f ratios of the patients ≤64 and ≥65 were statistically the same (27/12 vs. 18/15, respectively, p = 0.2). The mean age of the patients biopsied with 8G needles was 63.1. The m/f ratios of the patients ≤64 and ≥65 were statistically the same (30/26 vs. 26/23, respectively, p =0.5). 11 G specimens from younger patients, ≤64, were more frequently adequate (1.6 cm or greater) (39/53 = 73.5%) than specimens from older patients ≥ 65 (18/35 = 51.4%), p = 0.03. Conversely adequate 8G specimens were recovered as frequently in older patients ≥65 years (40/55 = 72.7%) as they were in younger patients ≤64 years, (59/72 = 81.9%) p = 0.21. Moreover, in older patients, adequate biopsy specimens were recovered more frequently by 8G needles then by 11G needles (40/55=72.7% vs. 18/35 = 51.4%, respectively, p = 0.04). Conclusions. 1. Age influences the rate of recovery of adequate bone marrow core biopsy specimens. 2. 8G needles recover adequate specimens more frequently than 11G needles in older patients.

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Expression of Angiopoietins and Their Receptor Tie2 in the Bone Marrow of Patients with Acute Myeloid Leukemia.

Blood ◽

10.1182/blood.v108.11.1894.1894 ◽

2006 ◽

Vol 108 (11) ◽

pp. 1894-1894

Author(s):

Christoph Schliemann ◽

Ralf Bieker ◽

Teresa Padro ◽

Torsten Kessler ◽

Heike Hintelmann ◽

...

Keyword(s):

Bone Marrow ◽

Acute Myeloid Leukemia ◽

Myeloid Leukemia ◽

Critical Role ◽

Angiogenic Factor ◽

Term Survival ◽

Bone Marrow Biopsies ◽

Cox Regression Analysis ◽

The Impact ◽

Acute Myeloid

Abstract Angiopoietin-1 (Ang-1) and its natural antagonist Angiopoietin-2 (Ang-2), both ligands for the receptor tyrosine kinase Tie2, are known to play an essential role in normal and pathological angiogenesis. However, the importance of angiopoietin signaling in the pathophysiology of hematologic neoplasias such as acute myeloid leukemia (AML) remains to be elucidated. We investigated the expression of Ang-1, Ang-2 and Tie2 by immunohistochemical analyses in bone marrow biopsies of 64 adult patients with newly diagnosed AML and correlated angiogenic factor expression with clinicopathological variables and long-term survival. Expression of Ang-2 was significantly increased in the bone marrow of AML patients (median [interquartile ranges]: 4.7 [3.3 – 5.7] AU [arbitrary units]) as compared with 16 control patients (1.5 [1.5 – 1.8] AU; P < 0.0001). In contrast, Ang-1 expression levels in AML patients did not differ from those found in controls. Thus, we observed a reversal of the Ang-1 and Ang-2 expression balance in the neoplastic bone marrow (Ang-2:Ang-1 ratio: 1.73) as compared with normal bone marrow (0.51; P < 0.0001). Furthermore, the angiopoietin receptor Tie2 was significantly overexpressed in leukemic blasts (3.8 [2.8 – 4.9] AU vs. 1.8 [1.6 – 2.3] AU; P < 0.0001). Patients expressing high levels of Ang-2 showed significantly longer overall survival (OS) than those with low Ang-2 levels (52.7 vs. 14.7 months; P = 0.039). The impact of Ang-2 expression on OS was especially evident in AML patients simultaneously expressing low levels of Ang-1 (P = 0.0298). Multivariate Cox regression analysis revealed karyotype and Ang-2 expression as independent prognostic factors for OS (hazard ratio [CI]: 3.06 [1.39 – 6.70] and 0.31 [0.14 – 0.69], respectively; P < 0.01). In conclusion, these data provide evidence that the alteration of angiopoietin balance in favor of Ang-2 may play a critical role in the pathophysiology of AML. Furthermore, high pre-therapeutic bone marrow Ang-2 levels indicate a favorable prognosis in polychemotherapy treated AML by a yet unknown mechanism.

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