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Li C, Zhang X, Zhuang X, Zhang K, Huang Q, Ge S, Wu Y, Hu R. The effectiveness of non-pharmacological interventions on reducing pain in patients undergoing bone marrow aspiration and biopsy: A systematic review and meta-analysis of randomized controlled trials. J Clin Nurs 2024; 33:2829-2848. [PMID: 38549254 DOI: 10.1111/jocn.17121] [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: 10/27/2023] [Revised: 02/01/2024] [Accepted: 03/11/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Patients often consider bone marrow aspiration and biopsy to be one of the most painful medical procedures. The effectiveness of non-pharmacological interventions to reduce pain during bone marrow aspiration and biopsy remains unclear. AIM To synthesize existing evidence regarding the effectiveness of non-pharmacological interventions in mitigating procedural pain among patients undergoing bone marrow aspiration and biopsy. DESIGN A systematic review and meta-analysis of randomized controlled trials. METHODS Six electronic databases, including PubMed, EMBASE, CINAHL, PsycINFO, Cochrane Library and Web of Science were searched from inception to July 15, 2023. The risk of bias was assessed using the Cochrane Risk of Bias Tool Version 2.0. Meta-analysis was conducted using STATA 16. The certainty of the evidence was assessed by the GRADE approach. RESULTS This meta-analysis included 18 studies derived from 17 articles involving a total of 1017 participants. The pooled results revealed statistically significant pain reduction effects using distraction (SMD: -.845, 95% CI: -1.344 to -.346, p < .001), powered bone marrow biopsy system (SMD: -.266, 95% CI: -.529 to -.003, p = .048), and acupoint stimulation (SMD: -1.016, 95% CI: -1.995 to -.037, p = .042) among patients undergoing bone marrow aspiration and biopsy. However, the pooled results on hypnosis (SMD: -1.228, 95% CI: -4.091 to 1.515, p = .368) showed no significant impact on pain reduction. Additionally, the pooled results for distraction did not demonstrate a significant effect on operative anxiety (MD: -2.942, 95% CI: -7.650 to 1.767, p = .221). CONCLUSIONS Distraction, powered bone marrow biopsy system and acupoint stimulation are effective in reducing pain among patients undergoing bone marrow aspiration and biopsy. PATIENT OR PUBLIC CONTRIBUTION Not applicable. RELEVANCE TO CLINICAL PRACTICE This meta-analysis highlights the effectiveness of distraction, powered bone marrow biopsy system and acupoint stimulation for reducing pain in patients undergoing bone marrow biopsy. Healthcare professionals should consider integrating these interventions into pain management practices for these patients. REGISTRATION (PROSPERO): CRD42023422854.
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Affiliation(s)
- Chengyang Li
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Xiao Zhang
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Xueting Zhuang
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Kun Zhang
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Qiyuan Huang
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Song Ge
- Department of Natural Sciences/Nursing, University of Houston-Downtown, Houston, Texas, USA
| | - Yong Wu
- Fujian Medical University Union Hospital, Fuzhou, China
| | - Rong Hu
- The School of Nursing, Fujian Medical University, Fuzhou, China
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Cooke TM, Maybody M, Aly AK, Petre EN, Santos E, Noy A, Chan AY, Lis E, Gangai N, Cornelis FH, Moussa AM. Factors Affecting Diagnostic Yield of Lesional Bone Biopsy in Hematologic Malignancy Patients. Cardiovasc Intervent Radiol 2024; 47:80-86. [PMID: 37910259 PMCID: PMC11149476 DOI: 10.1007/s00270-023-03594-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/11/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE To evaluate factors affecting the diagnostic yield (percent of biopsy samples leading to a pathologic diagnosis) of lesional bone biopsies in patients with hematologic malignancies. MATERIALS AND METHODS This retrospective study included 206 lesional bone biopsies in 182 patients with a hematologic malignancy between January 2017 and December 2022. The parameters that were reviewed to evaluate diagnostic yield included biopsy device type (manual vs. electric-powered drill), number of biopsy cores acquired, core biopsy needle gauge, preliminary intra-procedural sample adequacy (touch preparation cytology determining if samples are adequate for final pathologic examination), lesion morphology on Computed Tomography (CT), and presence of crush artifact. RESULTS Review of 206 lesional biopsies showed overall diagnostic yield to be 89.8% (185/206). The two statistically significant factors affecting diagnostic yield were biopsy device type and in-room adequacy. 41/42 samples obtained with the electric-powered drill and 144/164 samples obtained using a variety of manual needles were diagnostic (97.6% vs 87.8%, p = 0.03). Of the 192 samples that were assessed for sample adequacy intra-procedurally, 97/102 of the samples that were deemed adequate were diagnostic, and 77/90 of the samples where intra-procedural adequacy was not confirmed were diagnostic (95.1% vs 85.6%, p = 0.018). The remaining factors did not affect diagnostic yield. CONCLUSION The use of an electric-powered drill bone biopsy device and intra-procedural confirmation of sample adequacy are associated with a higher diagnostic yield of lesional bone biopsies in patients with hematologic malignancies. The presence or absence of crush artifact did not significantly affect the diagnostic yield in these patients. LEVEL OF EVIDENCE IV
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Affiliation(s)
- Timothy M Cooke
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA
- College of Medicine, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
| | - Majid Maybody
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA
| | - Ahmed K Aly
- Department of Radiology, University of Nebraska Medical Center, 981045 Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Elena N Petre
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA
| | - Ernesto Santos
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA
| | - Ariela Noy
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Alexander Y Chan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Eric Lis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA
| | - Natalie Gangai
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA
| | - Francois H Cornelis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA
| | - Amgad M Moussa
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA.
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Pabinger C, Dammerer D, Lothaller H, Kobinia GS. Reorientation technique has benefits in bone marrow aspiration of stem cells. Sci Rep 2022; 12:11637. [PMID: 35803965 PMCID: PMC9270485 DOI: 10.1038/s41598-022-15019-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/16/2022] [Indexed: 11/24/2022] Open
Abstract
We treated patients with osteoarthritis of the knee using injections of bone marrow aspirate concentrate (stem cell therapy). Since multiple controversial harvesting methods using different sites, needles, volumes and techniques have been described, we aimed to compare those methods. Four different harvesting sites at the iliac crest, three different types of needles, three different types of volumes and two different harvesting techniques were compared in 48 bone marrow aspirations. The conventional technique (Group 1) was compared with a reorientation technique (Group 2). The number of leucocytes and CD34 + cells and the viability in bone marrow aspirate (BMA) were analysed with a CytoFLEX Flow Cytometer. The reorientation technique showed significantly higher cell counts than the conventional technique in all parameters. Leucocytes per nl increased from 5 ± 2 to 12 ± 4 (p < .001), and CD 34 + cells per μl increased from 40 ± 40 to 140 ± 98 (p = .003). There was no difference between anterior and posterior harvesting at the iliac crest or between use of a thick and use of a thin needle. Use of the reorientation technique, compared to employing the conventional technique, has a significant advantage since the number of leucocytes and CD34 + cells can be tripled. For the use of bone marrow aspirate in the case of arthritis, it might therefore be a future option to harvest a maximum cell yield through the new reorientation technique and to omit centrifugation. However, the clinical relevance of these findings remains the subject of future studies. Level of Evidence: Level I. Clinical relevance: Enhanced technique of BMA for knee surgeons to ensure the maximum cell yield for stem cell therapy in regenerative medicine.
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Affiliation(s)
- Christof Pabinger
- IRM-Institute for Regenerative Medicine, Plüddemanngasse 45, 8010, Graz, Austria. .,Medical University of Innsbruck, Christof Probst Platz 1, 6020, Innsbruck, Austria.
| | - Dietmar Dammerer
- Medical University of Innsbruck, Christof Probst Platz 1, 6020, Innsbruck, Austria.,Department of Orthopaedics and Traumatology, University Hospital Krems, Krems, Austria
| | - Harald Lothaller
- Statistics, University of Music and Performing Arts, Leonhardstraße 15, 8010, Graz, Austria
| | - Georg Stefan Kobinia
- IRM-Institute for Regenerative Medicine, Plüddemanngasse 45, 8010, Graz, Austria
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Ho CK, Gimarc D, Carroll HF, Clay M, Schowinsky J, Jesse MK, Crawford AM, Marshall CB. Evaluating bone biopsy quality by technique in an animal model. RESEARCH IN DIAGNOSTIC AND INTERVENTIONAL IMAGING 2022; 2:100008. [PMID: 39076835 PMCID: PMC11265185 DOI: 10.1016/j.redii.2022.100008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 05/10/2022] [Indexed: 07/31/2024]
Abstract
Rationale and Objectives Powered bone biopsy technique is popular due to its ease of use. However, there is conflicting evidence regarding the diagnostic quality of the samples. The purpose of this study is to evaluate the diagnostic adequacy of different bone biopsy devices and techniques as it relates to the frequency of sample artifacts. Materials and Methods Bone biopsy was performed on same-day processed lamb femora using the following techniques: manual, pulsed powered and full powered. Ten samples were collected using each method by a single musculoskeletal-trained radiologist and were reviewed by 3 blinded pathologists. Samples were compared across multiple categories: length, bone dust, thermal/crush artifact, cellular morphology, fragmentation, and diagnostic acceptability. Bayesian Multilevel Nonlinear Regression models were performed assessing the association between the techniques across the categories. Results Statistical analysis revealed that the manual technique outperformed any powered technique across all categories: decreased thermal/crush artifact (P = 0.014), decreased bone dust (p<0.001), better cellular morphology (P = 0.005), less fragmentation (P < 0.0001) and better diagnostic acceptability (P < 0.0001). Conclusion Manually obtained bone biopsy samples generally produce a more diagnostic sample as compared to powered techniques in an animal model. Given these results, manual bone biopsy methods should be encouraged after consideration for lesion composition, difficulty of access and the patient's overall condition.
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Affiliation(s)
- Corey K Ho
- University of Colorado – Anschutz Medical Campus, Department of Radiology, 12401 E 17th Ave, Aurora, CO 80045, USA
| | - David Gimarc
- University of Colorado – Anschutz Medical Campus, Department of Radiology, 12401 E 17th Ave, Aurora, CO 80045, USA
| | - Hsieng-Feng Carroll
- University of Colorado – Anschutz Medical Campus, Department of Radiology, 12401 E 17th Ave, Aurora, CO 80045, USA
| | - Michael Clay
- University of Colorado – Anschutz Medical Campus, Department of Pathology, 12401 E 17th Ave, Aurora, CO 80045, USA
| | - Jeffrey Schowinsky
- University of Colorado – Anschutz Medical Campus, Department of Pathology, 12401 E 17th Ave, Aurora, CO 80045, USA
| | - MK Jesse
- University of Colorado – Anschutz Medical Campus, Department of Radiology, 12401 E 17th Ave, Aurora, CO 80045, USA
| | - Amanda M Crawford
- University of Utah – Department of Radiology and Imaging Sciences, University of Utah Hospital, 50 2030 E, Salt Lake City, UT 84132, USA
| | - Carrie B Marshall
- University of Colorado – Anschutz Medical Campus, Department of Pathology, 12401 E 17th Ave, Aurora, CO 80045, USA
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Mihailescu SD, Jaselme P, Fontoura ML, Feddag-Hannachi L, Veresezan EL, Drieux F, Camus V, Bouclet F, Tilly H, Cardinaël N, Jardin F. Comparison of bone marrow trephine sample quality between a drill-powered system and a manual needle system. Ann Diagn Pathol 2022; 59:151952. [DOI: 10.1016/j.anndiagpath.2022.151952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/14/2022] [Indexed: 11/26/2022]
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Chang CY, Husseini JS, Moreira A, Simeone FJ, Yee AJ, Bredella MA, Hasserjian R. CT-guided bone marrow aspirations and biopsies: retrospective study and comparison with blind procedures. Skeletal Radiol 2020; 49:1285-1294. [PMID: 32232499 DOI: 10.1007/s00256-020-03423-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/14/2020] [Accepted: 03/16/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the pathology results of CT-guided and blind bone marrow aspirations and biopsies. METHODS Ninety-eight consecutive CT-guided biopsies and 98 age- and gender-matched blind (non-CT-guided) posterior iliac crest bone marrow aspirations and biopsies performed in 2017 were reviewed for adequacy of core biopsies and aspirate smears. CT procedure images and CT abdomen/pelvis images were reviewed to evaluate anatomic features of the posterior ilium and soft tissues. Statistical analysis was performed using a T test, Fisher exact test, and Kruskal-Wallis test. RESULTS There was no significant difference in the age and gender of the two groups (p > 0.05). However, the CT-guided group had a higher BMI (p = 0.0049) and posterior soft tissue thickness (p = 0.0016). More CT-guided biopsy samples (CT 93 (95%); blind 77 (79%); p = 0.0006) and aspirate smears (CT 90 (92%); blind 78 (80%); p = 0.042) were categorized as adequate. The CT-guided group had longer core lengths (CT 1.4 ± 0.6 (range 0.3-3.5) cm; blind 1.0 ± 0.60 (range 0-2.6) cm; p = 0.0001). Overall, 131/164 (80%) of the cases had at least one of the described features (slanted posterior ilium (angle > 30°), 30%; rounded posterior ilium, 20%; thick posterior ilium cortex, 13%; focal lesion in posterior ilium, 12%; prior procedure in posterior ilium, 5%; posterior soft tissue thickness > 3 cm, 40%). CONCLUSION CT-guided bone marrow procedures were more likely to result in both adequate aspirate smears and biopsy samples and longer core lengths when compared with blind procedures.
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Affiliation(s)
- C Y Chang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Cambridge, MA, USA.
| | - J S Husseini
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Cambridge, MA, USA
| | - A Moreira
- Department of Radiology, Centro Hospitalar São João, Porto, Portugal
| | - F J Simeone
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - A J Yee
- Harvard Medical School, Cambridge, MA, USA.,Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - M A Bredella
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Cambridge, MA, USA
| | - R Hasserjian
- Harvard Medical School, Cambridge, MA, USA.,Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
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