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Ogata K, Mochimaru Y, Kasai N, Sei K, Kawahara N, Ogata M, Yamamoto Y. 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. Br J Haematol 2024; 204:1856-1861. [PMID: 38590011 DOI: 10.1111/bjh.19447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/10/2024]
Abstract
Bone marrow (BM) examination is a key element in the diagnosis and prognostic grading of myelodysplastic syndromes (MDSs), and obtaining adequate BM cell samples is critical for accurate test results. Massive haemodilution of aspirated BM samples is a well-known problem; however, its incidence in patients with MDS has not been well studied. We report the first study to examine the incidence of massive haemodilution in nationwide BM samples aspirated from patients diagnosed with or suspected of MDS in Japan. Among 283 cases available for analysis, BM smears from 92 cases (32.5%) were hypospicular (massively haemodiluted) and, particularly, no BM particles were observed in 52 cases (18.4%). Regarding hypospicular cases, we examined how the doctors in charge interpreted the BM smears of their patients. In only 19 of 92 cases (20.7%), doctors realised that the BM smears were haemodiluted. Furthermore, the BM biopsy, which can help diagnose hypospicular cases, was oftentimes not performed when the haemodilution was overlooked by doctors (not performed in 50 of 73 such cases). These real-world data highlight that not only researchers who are working to improve diagnostic tests but also clinicians who perform and use diagnostic tests must realise this common and potentially critical problem.
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Affiliation(s)
- Kiyoyuki Ogata
- Department of Haematology, Metropolitan Research and Treatment Centre for Blood Disorders (MRTC Japan), Tokyo, Japan
| | - Yuto Mochimaru
- Department of Haematology, Metropolitan Research and Treatment Centre for Blood Disorders (MRTC Japan), Tokyo, Japan
| | - Nana Kasai
- Department of Haematology, Metropolitan Research and Treatment Centre for Blood Disorders (MRTC Japan), Tokyo, Japan
| | - Kazuma Sei
- Department of Haematology, Metropolitan Research and Treatment Centre for Blood Disorders (MRTC Japan), Tokyo, Japan
| | - Naoya Kawahara
- Department of Haematology, Metropolitan Research and Treatment Centre for Blood Disorders (MRTC Japan), Tokyo, Japan
| | - Mika Ogata
- Department of Haematology, Metropolitan Research and Treatment Centre for Blood Disorders (MRTC Japan), Tokyo, Japan
| | - Yumi Yamamoto
- Department of Haematology, Metropolitan Research and Treatment Centre for Blood Disorders (MRTC Japan), Tokyo, Japan
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Ali SF, Cloe A, Siaghani PJ, Himchak E, Cantu D, Gaal K, Kim YS, Afkhami M, Pillai R, Chan W, Quirk E, Weisenburger DD, Aoun P, Song JY. Bone Marrow Collection: Comparison of Unassisted vs Assisted Bedside Collections by a Laboratory Technologist. Am J Clin Pathol 2022; 157:573-577. [PMID: 34788366 DOI: 10.1093/ajcp/aqab165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/24/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Bone marrow collections are often difficult, and creating quality smears and touch preparations at the bedside can prove challenging. The objective of this study is to compare the quality of bone marrow specimens between unassisted and assisted bone marrow collections by a bone marrow technologist. METHODS Data for this study were collected from 422 hematopathology reports over 14 months. We recorded the bone marrow quality of the different parts (aspirate smears, touch imprints, core biopsy, and clot/particle sections) as adequate, suboptimal, or inadequate. Student t test statistical analysis was performed between the corresponding parts in the two groups. RESULTS Our results demonstrate that the quality of assisted bone marrow specimens is significantly better compared with unassisted specimens, particularly for the aspirate smears (P < .0001) and touch imprints (P < .0001). Notably, the quality of aspirate smears was improved, which is important for cytologic evaluation. CONCLUSIONS We conclude that assistance by a bone marrow technologist resulted in a significant improvement in the quality of bone marrow collection.
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Affiliation(s)
- Saba F Ali
- Department of Pathology, Roswell Park, Buffalo, NY, USA
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Adam Cloe
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
- Quest Diagnostics, Woodland Hills, CA, USA
| | - Parwiz J Siaghani
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
- Long Beach Memorial Medical Center, Long Beach, CA, USA
| | - Evan Himchak
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
- Department of Pathology, Texas Health Presbyterian Hospital, Dallas, TX, USA
| | - David Cantu
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
- Department of Pathology, Creighton University School of Medicine, Omaha, NE, USA
| | - Karl Gaal
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Young S Kim
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Michelle Afkhami
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Raju Pillai
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Wanda Chan
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Elizabeth Quirk
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | | | - Patricia Aoun
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Joo Y Song
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
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Dalili D, Isaac A, Garnon J, Cazzato RL, Gangi A. Towards Personalized Musculoskeletal Interventional Oncology: Enhanced Image-Guided Biopsies and Interventions. Semin Roentgenol 2022; 57:201-211. [DOI: 10.1053/j.ro.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 11/11/2022]
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Riley RS, Gandhi P, Harley SE, Garcia P, Dalton JB, Chesney A. A Synoptic Reporting System to Monitor Bone Marrow Aspirate and Biopsy Quality. J Pathol Inform 2021; 12:23. [PMID: 34447603 PMCID: PMC8356705 DOI: 10.4103/jpi.jpi_53_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/20/2020] [Accepted: 08/13/2020] [Indexed: 11/04/2022] Open
Abstract
Objectives: Bone marrow evaluation plays a critical role in the diagnosis, staging, and monitoring of many diseases. Although there are standardized guidelines for assessing bone marrow specimen quality, there is a lack of evidence-based tools to perform such assessments. The objective was to monitor bone marrow sample quality in real time by standardizing the basic components of a synoptic report and incorporating it into a bone marrow report template. Materials and Methods: A relational database of bone marrow quality parameters was developed and incorporated into our laboratory information system bone marrow report template, with data entry completed during specimen sign out. Data from multiple reports created within a date range were extracted by Structured Query Language query, and summarized in tabular form. Reports generated from these data were utilized in quality improvement efforts. Results: The synoptic reporting system was routinely used to record the quality of bone marrow specimens from adult patients. Data from 3189 bone marrow aspirates, 3302 biopsies, and 3183 biopsy touch imprints identified hemodilution as the principal issue affecting bone marrow aspirate quality, whereas aspiration artifact and fragmentation affected bone marrow biopsy quality. Conclusions: The bone marrow synoptic reporting process was easy to use, readily adaptable, and has proved a useful component of the overall quality assurance process to optimize bone marrow quality.
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Affiliation(s)
- Roger S Riley
- Department of Pathology, VCU School of Medicine, MCV Campus of Virginia Commonwealth University, Richmond, VA, USA
| | | | - Susan E Harley
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AK, USA
| | | | - Justin B Dalton
- Department of Pathology, VCU School of Medicine, MCV Campus of Virginia Commonwealth University, Richmond, VA, USA
| | - Alden Chesney
- Department of Pathology, VCU School of Medicine, MCV Campus of Virginia Commonwealth University, Richmond, VA, USA
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Feddahi N, Herten M, Tassemeier T, Rekasi H, Hackel A, Haversath M, Jäger M. Does Needle Design Affect the Regenerative Potential of Bone Marrow Aspirate? An In Vitro Study. Life (Basel) 2021; 11:748. [PMID: 34440491 PMCID: PMC8401947 DOI: 10.3390/life11080748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/17/2022] Open
Abstract
While autologous bone is still the gold standard for treatment of bone defects, its availability is limited. Sufficient numbers of mesenchymal stroma cells (MSC) may be an alternative. Small volumes of bone marrow aspirate (BMA) were harvested with two different needle systems comparing the yield and regenerative potency of the MSCs. BMA (10 mL) was aspirated from the posterior iliac crest of 12 patients with degenerative spinal disc disease using both needle systems in each patient: the Jamshidi needle (JAM) and on the contralateral side the Marrow Cellution® Needle (AMC). Number of mononuclear cells (MNCs) and regeneration capacity (colony-forming unit/CFU) were determined. MSCs were characterized for surface markers and their differentiation into trilineages. There was no significant difference between the two harvesting needles regarding the quantity of MNCs in BMA: 5.2 ± 1.8 × 109 MNC/mL for AMC vs. 4.8 ± 2.5 × 109 MNC/mL for JAM, p = 0.182. The quantity of CFUs per ml BMA was similar for both groups: 3717 ± 5556 for AMC and 4305 ± 5507 for JAM (p = 0.695). The potency of MSCs expressed as colony-forming potential per 106 MNC resulted in 0.98 ± 1.51 for AMC and 1.00 ± 0.96 for JAM (p = 0.666). Regardless of the needle design, 10 mL bone marrow aspirate contains a sufficient number of about 40,000 MSCs that can be used to enhance bone healing.
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Affiliation(s)
- Nadia Feddahi
- Department of Orthopedic and Trauma Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, D-45147 Essen, Germany; (H.R.); (M.H.)
| | - Monika Herten
- Clinic of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, D-45147 Essen, Germany;
| | - Tjark Tassemeier
- Department of Orthopedic, Gelenkzentrum Bergisch Land, Freiheitstraße 203, D-42853 Remscheid, Germany;
| | - Heike Rekasi
- Department of Orthopedic and Trauma Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, D-45147 Essen, Germany; (H.R.); (M.H.)
| | - Alexander Hackel
- Department of Otorhinolaryngology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, D-45147 Essen, Germany;
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
| | - Marcel Haversath
- Department of Orthopedic and Trauma Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, D-45147 Essen, Germany; (H.R.); (M.H.)
- Department of Orthopedic, St. Vinzenz Krankenhaus Düsseldorf, Schloßstraße 85, D-40477 Düsseldorf, Germany
| | - Marcus Jäger
- Department of Trauma, Reconstruction and Orthopedic Surgery, St. Marien Hospital, Mülheim an der Ruhr, Kaiserstraße 50, D-45468 Mülheim an der Ruhr, Germany;
- Orthopedics and Trauma Surgery, University of Duisburg Essen, D-45147 Essen, Germany
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Padhi S, Ravichandran K, Varghese RG, Basheer A, Mookappan S, Iqbal N. Bone marrow aspiration and gross appearance of trephine biopsy in routine practice: a preliminary descriptive data on 176 consecutive cases from a single tertiary care center in South India. J Hematop 2021. [DOI: 10.1007/s12308-021-00449-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Gendron N, Zia Chahabi S, Poenou G, Rivet N, Belleville-Rolland T, Lemaire P, Escuret A, Ciaudo M, Curis E, Gaussem P, Siguret V, Darnige L. Pain assessment and factors influencing pain during bone marrow aspiration: A prospective study. PLoS One 2019; 14:e0221534. [PMID: 31465426 PMCID: PMC6715342 DOI: 10.1371/journal.pone.0221534] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/08/2019] [Indexed: 11/29/2022] Open
Abstract
Although bone marrow aspiration (BMA) is still considered a painful procedure, pain level remains poorly documented. We therefore conducted a prospective study intended to evaluate pain level in adult patients undergoing BMA at the sternal or iliac crest site to identify factors associated with pain. We enrolled a total of 448 patients who underwent 461 BMA and asked those patients to score their pain intensity after BMA using numerical pain rating scale (NPRS). The following factors: level of anxiety, quality of the information given to the patient, operator’s experience, and bone texture were recorded using a standardized questionnaire. The median NPRS score was 3.5 (IQR [2.0; 5.0]) the sternal site (n = 405) was associated with an increased median NPRS score (3.5 [2.0; 5.0]) compared to the iliac crest (n = 56, 2.5 [1.0; 4.0]; p<0.0001). For those patients who underwent sternal BMA, the median NPRS score was significantly lower when using lidocaine infiltration (p = 0.0159) as compared with no anesthetic use. Additionally there was no significant effect of anesthetic cream found. After multivariate analysis, the model of NPRS score at the sternal site included patient anxiety (p<0.0001) and the use of lidocaine infiltration (0.0378). This study underlines the usefulness of a comprehensive management including pain relief and efforts to reduce anxiety including appropriate information given to the patient during BMA.
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Affiliation(s)
- Nicolas Gendron
- AP-HP, Hôpital Européen Georges Pompidou, Service d’Hématologie Biologique, Paris, France
- Université de Paris, Paris, France
- INSERM UMR-S1140, Paris, France
| | - Sara Zia Chahabi
- AP-HP, Hôpital Européen Georges Pompidou, Service d’Hématologie Biologique, Paris, France
- Université de Paris, Paris, France
- AP-HP, Hôpital Lariboisière, Paris, France
| | - Géraldine Poenou
- AP-HP, Hôpital Européen Georges Pompidou, Service d’Hématologie Biologique, Paris, France
- Université de Paris, Paris, France
| | - Nadia Rivet
- AP-HP, Hôpital Européen Georges Pompidou, Service d’Hématologie Biologique, Paris, France
- Université de Paris, Paris, France
- INSERM UMR-S1140, Paris, France
| | - Tiphaine Belleville-Rolland
- AP-HP, Hôpital Européen Georges Pompidou, Service d’Hématologie Biologique, Paris, France
- Université de Paris, Paris, France
- INSERM UMR-S1140, Paris, France
| | - Pierre Lemaire
- AP-HP, Hôpital Européen Georges Pompidou, Service d’Hématologie Biologique, Paris, France
| | - Antoine Escuret
- AP-HP, Hôpital Européen Georges Pompidou, Service d’Hématologie Biologique, Paris, France
- Université de Paris, Paris, France
| | - Michèle Ciaudo
- AP-HP, Hôpital Européen Georges Pompidou, Service d’Hématologie Biologique, Paris, France
| | - Emmanuel Curis
- Université de Paris, Paris, France
- Laboratoire de Biomathématiques, plateau iB, Faculté de Pharmacie de Paris, Université Paris Descartes, Paris, France
- Service de Biostatistiques et Informatique Médicale, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Pascale Gaussem
- AP-HP, Hôpital Européen Georges Pompidou, Service d’Hématologie Biologique, Paris, France
- Université de Paris, Paris, France
- INSERM UMR-S1140, Paris, France
| | - Virginie Siguret
- AP-HP, Hôpital Européen Georges Pompidou, Service d’Hématologie Biologique, Paris, France
- Université de Paris, Paris, France
- INSERM UMR-S1140, Paris, France
- AP-HP, Hôpital Lariboisière, Paris, France
| | - Luc Darnige
- AP-HP, Hôpital Européen Georges Pompidou, Service d’Hématologie Biologique, Paris, France
- Université de Paris, Paris, France
- INSERM UMR-S1140, Paris, France
- * E-mail:
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Brestoff JR, Toland A, Afaneh K, Qavi AJ, Press B, Westervelt P, Kreisel F, Hassan A. Bone Marrow Biopsy Needle Type Affects Core Biopsy Specimen Length and Quality and Aspirate Hemodilution. Am J Clin Pathol 2019; 151:185-193. [PMID: 30307478 DOI: 10.1093/ajcp/aqy126] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives Bone marrow biopsies are essential for evaluating patients with suspected or confirmed hematopoietic disorders or malignancies, but little is known about how biopsy needle type affects biopsy length and/or quality. We sought to compare bone marrow biopsy quality in specimens obtained with two different needles. Methods A retrospective analysis was performed on bone marrow specimens obtained with manual single-bevel (n = 114) or triple-bevel (n = 166) needles. The lengths of evaluable marrow, core quality, and aspirate quality were assessed by blinded hematopathologists. Results The triple-bevel needle produced 1.33-mm shorter lengths of evaluable marrow than the single-bevel needle and was five times less likely to produce a specimen rated as "adequate" and 4.2 times more likely to produce crush artifact. The triple-bevel needle was also 2.4 times more likely to produce hemodilute aspirates. Conclusions Bone marrow biopsy needle type affects the length of evaluable marrow and quality of core and aspirate specimens.
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Affiliation(s)
- Jonathan R Brestoff
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO
| | - Angus Toland
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO
| | - Khalid Afaneh
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO
| | - Abraham J Qavi
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO
| | - Barbara Press
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St Louis, MO
| | - Peter Westervelt
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St Louis, MO
| | - Friederike Kreisel
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO
| | - Anjum Hassan
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO
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Merzianu M, Groman A, Hutson A, Cotta C, Brynes RK, Orazi A, Reddy V, Teruya-Feldstein J, Amre R, Balasubramanian M, Brandao G, Cherian S, Courville E, Czuchlewski D, Fan G, Grier D, Hoehn D, Inamdar KV, Juskevicius R, Kaur P, Lazarchick J, Lewis MR, Miles RR, Myers JB, Nasr MR, Qureishi HN, Olteanu H, Robu VG, Salaru G, Vajpayee N, Vos J, Zhang L, Zhang S, Aye L, Brega E, Coad JE, Grantham J, Ivelja S, McKenna R, Sultan K, Wilding G, Hutchison R, Peterson L, Cheney RT. Trends in Bone Marrow Sampling and Core Biopsy Specimen Adequacy in the United States and Canada: A Multicenter Study. Am J Clin Pathol 2018; 150:393-405. [PMID: 30052721 PMCID: PMC6166687 DOI: 10.1093/ajcp/aqy066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To assess bone marrow (BM) sampling in academic medical centers. METHODS Data from 6,374 BM samples obtained in 32 centers in 2001 and 2011, including core length (CL), were analyzed. RESULTS BM included a biopsy (BMB; 93%) specimen, aspirate (BMA; 92%) specimen, or both (83%). The median (SD) CL was 12 (8.5) mm, and evaluable marrow was 9 (7.6) mm. Tissue contraction due to processing was 15%. BMB specimens were longer in adults younger than 60 years, men, and bilateral, staging, and baseline samples. Only 4% of BMB and 2% of BMB/BMA samples were deemed inadequate for diagnosis. BM for plasma cell dyscrasias, nonphysician operators, and ancillary studies usage increased, while bilateral sampling decreased over the decade. BM-related quality assurance programs are infrequent. CONCLUSIONS CL is shorter than recommended and varies with patient age and sex, clinical circumstances, and center experience. While pathologists render diagnoses on most cases irrespective of CL, BMB yield improvement is desirable.
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Affiliation(s)
- Mihai Merzianu
- Pathology and Laboratory Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Adrienne Groman
- Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Alan Hutson
- Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Claudiu Cotta
- Laboratory Medicine, Cleveland Clinic, Cleveland, OH
| | | | - Attilio Orazi
- Pathology, Weill Cornell Medical College, New York, NY
| | | | | | - Ramila Amre
- Pathology, McGill University Health Centre , Royal Victoria Hospital, Montreal, Canada
| | | | - Guilherme Brandao
- Pathology, McGill University Jewish General Hospital, Montreal, Canada
| | | | | | | | - Guang Fan
- Pathology, Oregon Health and Science University, Portland
| | - David Grier
- Pathology, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Daniela Hoehn
- Pathology and Cell Biology, Columbia University Medical Center, New York, NY
| | | | - Ridas Juskevicius
- Pathology, East Carolina University Brody School of Medicine, Greenville, NC
| | - Prabhjot Kaur
- Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - John Lazarchick
- Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston
| | - Michael R Lewis
- Pathology and Laboratory Medicine, University of Vermont, Burlington
| | | | - Jerome B Myers
- Pathology, Penrose Saint Francis Health Services, Colorado Springs, CO
| | | | - Hina N Qureishi
- Pathology and Microbiology, University of Nebraska Medical Center, Omaha
| | | | | | - Gratian Salaru
- Clinical Pathology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Neerja Vajpayee
- Pathology, State University of New York Upstate Medical University, Syracuse
| | - Jeffrey Vos
- Pathology, West Virginia University, Morgantown
| | - Ling Zhang
- Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Shanxiang Zhang
- Pathology and Laboratory Medicine, Indiana University, Indianapolis
| | - Le Aye
- Pathology, Keck School of Medicine of USC, Los Angeles
| | - Elisa Brega
- Pathology, McGill University Jewish General Hospital, Montreal, Canada
| | | | | | - Sinisa Ivelja
- Pathology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Robert McKenna
- Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | | | - Gregory Wilding
- Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Robert Hutchison
- Pathology, State University of New York Upstate Medical University, Syracuse
| | | | - Richard T Cheney
- Pathology and Anatomical Sciences, University at Buffalo–The State University of New York
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10
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Yang RK, Nazeef M, Patel SS, Mattison R, Yang DT, Ranheim EA, Leith CP. Improving bone marrow biopsy quality through peer discussion and data comparisons: A single institution experience. Int J Lab Hematol 2018; 40:419-426. [PMID: 29575638 DOI: 10.1111/ijlh.12804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 02/07/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Bone marrow biopsy (BMB) is crucial for the diagnosis, staging, and monitoring of a variety of hematologic diseases. Obtaining an adequate BMB can be challenging given the need to balance patient comfort with acquisition of high quality specimens. We had observed variable BMB quality at our institution with poor quality specimens sometimes affecting diagnosis. We thus undertook this quality improvement (QI) project to improve the quality of diagnostic BMB specimens. METHODS We used an A3 QI process to identify factors possibly influencing BMB quality. We collected baseline data on 211 BMB, with short and long-term follow-up data on a further 382 cases. We used clinical conferences to discuss data, perform peer comparisons and identify strategies to create a sustainable improvement in BMB quality. RESULTS Baseline data showed that BMB length was influenced most by the individual performer, with some influence of needle gauge. Other factors such as sedation, BMB indication were noncontributory. BMB lengths improved following performer education and individual performer data comparisons (15.2 mm post vs 12.8 mm baseline, P < .0001) and with use of an 8- rather than 11-gauge needle (18.3 mm 8-gauge vs 13.3 mm 11-gauge P < .0001), and were sustained over the long term. CONCLUSIONS Education on BMB standards, sharing of performer data, and changing needle gauge are relatively straightforward methods to improve BMB quality, leading to easier pathology diagnosis.
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Affiliation(s)
- R K Yang
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - M Nazeef
- Division of Hematology and Medical Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - S S Patel
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - R Mattison
- Division of Hematology and Medical Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - D T Yang
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - E A Ranheim
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - C P Leith
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Astle JM, Xu ML, Friedman T, Brown E. Limitations of poor bone marrow aspirations (for an accurate diagnosis) despite the multimodal analytical era: A longitudinal retrospective study. Am J Hematol 2017; 92:E600-E602. [PMID: 28670759 DOI: 10.1002/ajh.24839] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 06/21/2017] [Accepted: 06/24/2017] [Indexed: 11/11/2022]
Affiliation(s)
- John M. Astle
- Pathology and Laboratory Medicine; Medical College of Wisconsin; Milwaukee Wisconsin
| | - Mina L. Xu
- Hematopathology, Pathology and of Laboratory Medicine; Yale School of Medicine; New Haven Connecticut
| | | | - Elliott Brown
- Diagnostic Radiology and Bioimaging Sciences; Yale University School of Medicine; New Haven Connecticut
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Arber DA, Borowitz MJ, Cessna M, Etzell J, Foucar K, Hasserjian RP, Rizzo JD, Theil K, Wang SA, Smith AT, Rumble RB, Thomas NE, Vardiman JW. Initial Diagnostic Workup of Acute Leukemia: Guideline From the College of American Pathologists and the American Society of Hematology. Arch Pathol Lab Med 2017; 141:1342-1393. [PMID: 28225303 DOI: 10.5858/arpa.2016-0504-cp] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - A complete diagnosis of acute leukemia requires knowledge of clinical information combined with morphologic evaluation, immunophenotyping and karyotype analysis, and often, molecular genetic testing. Although many aspects of the workup for acute leukemia are well accepted, few guidelines have addressed the different aspects of the diagnostic evaluation of samples from patients suspected to have acute leukemia. OBJECTIVE - To develop a guideline for treating physicians and pathologists involved in the diagnostic and prognostic evaluation of new acute leukemia samples, including acute lymphoblastic leukemia, acute myeloid leukemia, and acute leukemias of ambiguous lineage. DESIGN - The College of American Pathologists and the American Society of Hematology convened a panel of experts in hematology and hematopathology to develop recommendations. A systematic evidence review was conducted to address 6 key questions. Recommendations were derived from strength of evidence, feedback received during the public comment period, and expert panel consensus. RESULTS - Twenty-seven guideline statements were established, which ranged from recommendations on what clinical and laboratory information should be available as part of the diagnostic and prognostic evaluation of acute leukemia samples to what types of testing should be performed routinely, with recommendations on where such testing should be performed and how the results should be reported. CONCLUSIONS - The guideline provides a framework for the multiple steps, including laboratory testing, in the evaluation of acute leukemia samples. Some aspects of the guideline, especially molecular genetic testing in acute leukemia, are rapidly changing with new supportive literature, which will require on-going updates for the guideline to remain relevant.
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13
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Renshaw AA, Gould EW. Comparison of Accuracy and Speed of Information Identification by Nonpathologists in Synoptic Reports With Different Formats. Arch Pathol Lab Med 2017; 141:418-422. [PMID: 28055242 DOI: 10.5858/arpa.2016-0216-oa] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - The College of American Pathologists requires synoptic reports for specific types of pathology reports. OBJECTIVE - To compare the accuracy and speed of information retrieval in synoptic reports of different formats. DESIGN - We assessed the performance of 28 nonpathologists from 4 different types of users (cancer registrars, MDs, medical non-MDs, and nonmedical) at identifying specific information in various formatted synoptic reports, using a computerized quiz that measured both accuracy and speed. RESULTS - There was no significant difference in the accuracy of data identification for any user group or in any format. While there were significant differences in raw time between users, these were eliminated when normalized times were used. Compared with the standard format of a required data element (RDE) and response on 1 line, both a list of responses without an RDE (21%, P < .001) and a paired response with more concise text (33%, P < .001) were significantly faster. In contrast, both the 2-line format (RDE header on one line, response indented on the second line) (12%, P < .001) and a report with the RDE response pairs in a random order were significantly slower (16%, P < .001). CONCLUSIONS - There are significant differences in ease of use by nonpathologists between different synoptic report formats. Such information may be useful in deciding between different format options.
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Affiliation(s)
| | - Edwin W Gould
- From the Department of Pathology, Baptist Hospital and Baptist Health of South Florida Healthcare System, Miami
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Chang CY, Huang AJ, Bredella MA, Torriani M, Halpern EF, Rosenthal DI, Springfield DS. Percutaneous CT-guided needle biopsies of musculoskeletal tumors: a 5-year analysis of non-diagnostic biopsies. Skeletal Radiol 2015; 44:1795-803. [PMID: 26338069 DOI: 10.1007/s00256-015-2235-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/06/2015] [Accepted: 08/10/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To study non-diagnostic CT-guided musculoskeletal biopsies and take steps to minimize them. Specifically we asked: (1) What malignant diagnoses have a higher non-diagnostic rate? (2) What factors of a non-diagnostic biopsy may warrant more aggressive pursuit? (3) Do intra-procedural frozen pathology (FP) or point-of-care (POC) cytology reduce the non-diagnostic biopsy rate? MATERIALS AND METHODS This study was IRB-approved and HIPAA-compliant. We retrospectively reviewed 963 consecutive CT-guided musculoskeletal biopsies. We categorized pathology results as malignant, benign, or non-diagnostic and recorded use of FP or POC cytology. Initial biopsy indication, final diagnosis, method of obtaining the final diagnosis of non-diagnostic biopsies, age of the patient, and years of biopsy attending experience were recorded. Groups were compared using Pearson's χ(2) test or Fisher's exact test. RESULTS In all, 140 of 963 (15%) biopsies were non-diagnostic. Lymphoma resulted in more non-diagnostic biopsies (P < 0.0001). While 67% of non-diagnostic biopsies yielded benign diagnoses, 33% yielded malignant diagnoses. Patients whose percutaneous biopsy was indicated due to the clinical context without malignancy history almost always generated benign results (96%). Whereas 56% of biopsies whose indication was an imaging finding of a treatable lesion were malignant, 20% of biopsies whose indication was a history of malignancy were malignant. There was no statistically significant difference in the nondiagnostic biopsy rates of pediatric versus adult patients (P = 0.8) and of biopsy attendings with fewer versus more years of experience (P = 0.5). The non-diagnostic rates of biopsies with FP (8%), POC cytology (25%), or neither (24%) were significantly different (P < 0.0001). CONCLUSION Lymphoma is the malignant diagnosis most likely to result in a non-diagnostic biopsy. If the clinical and radiologic suspicion for malignancy is high, repeat biopsy is warranted. If the clinical context suggests a benign lesion, a non-diagnostic biopsy may be considered reassuring. Frozen pathology may decrease the non-diagnostic biopsy rate.
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Affiliation(s)
- Connie Y Chang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA.
| | - Ambrose J Huang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA.
| | - Miriam A Bredella
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA.
| | - Martin Torriani
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA.
| | - Elkan F Halpern
- Institute for Technology Assessment, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
| | - Daniel I Rosenthal
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA.
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Grønkjær M, Hasselgren CF, Østergaard ASL, Johansen P, Korup J, Bøgsted M, Bilgrau AE, Jensen P. Bone Marrow Aspiration: A Randomized Controlled Trial Assessing the Quality of Bone Marrow Specimens Using Slow and Rapid Aspiration Techniques and Evaluating Pain Intensity. Acta Haematol 2015; 135:81-7. [PMID: 26505268 DOI: 10.1159/000438480] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 07/08/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Bone marrow aspiration (BMA) is an essential procedure in the examination of hematological disorders, but there is limited evidence as to whether the aspiration rate affects specimen quality. We aimed to assess the specimen quality and pain intensity using slow (S-technique) or rapid (R-technique) aspiration. METHODS This was a single-center, prospective, randomized patient- and assessor-blinded study of 482 patients scheduled for BMA. Specimen quality was evaluated by grading bone marrow (BM) cellularity and counting the number of marrow particles. Pain was assessed using a visual analog scale (VAS). RESULTS We found a significant difference between the 2 groups with regard to the quality of specimens. For cellularity, the odds ratio (OR) for having a poor quality aspirate using the S-technique versus the R-technique was 3.05 [confidence interval (CI) 1.79-5.31]. For BM particles, the quality of specimens with the S-technique proved to be poor compared with the R-technique (OR 2.52; CI 1.51-4.28). We found a statistically significant difference of 1 VAS point (p < 0.001) of the median pain intensity in favor of the S-technique. CONCLUSION Even though the pain intensity is significantly higher with the R-technique, the median difference is relatively small. We propose that the R-technique is preferable to the S-technique due to better specimen quality.
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Affiliation(s)
- Mette Grønkjær
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
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Loureiro G, Rizzatti EG, Sandes AF, de Lourdes Chauffaille M. Quality control of bone marrow aspirates: additional steps toward a safer and more efficient procedure. Cancer 2014; 120:1441-2. [PMID: 24481771 DOI: 10.1002/cncr.28602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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17
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Odejide OO, Jacobson JO, Abel GA. Reply to quality control of bone marrow aspirates: additional steps toward a safer and more efficient procedure. Cancer 2014; 120:1442. [PMID: 24481832 DOI: 10.1002/cncr.28603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Oreofe O Odejide
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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