Trained clinical nurse specialists proficiently obtain bone marrow aspirates and trephine biopsies in a nearly painless procedure—a prospective evaluation study

Abstract

Patients often experience bone marrow examinations (BMEs) as frightening and painful. Varying operators and uncertainty about who will perform the BME worsen their anxiety. In our study, clinical nurse specialists (CNSs) were trained to perform BMEs to ensure continuity and to test the feasibility, patient satisfaction, and biopsy quality. This exploratory evaluation assessed 574 BMEs at our tertiary center between January 2012 and February 2013, 398 BMEs performed by CNS and 176 by physicians. Our aims were to determine whether BMEs by CNS yield results similar to those of physicians, analyzing (1) patient satisfaction with the BME (a) consent and (b) performance, (2) induced pain, and (3) quality of aspirates and length of trephine biopsies. When performed by CNS, 100 % of the patients were satisfied with the consent procedure and 99 % with the BME performance (physicians 99 and 91 %, respectively). The median pain score was low when both CNS and physicians performed the BME, with no or only mild pain in 92 and 76 % of patients, respectively. Bone marrow (BM) aspirates by CNS and physicians were assessed as technically evaluable in ~70 %; moreover, the median length of trephine biopsies was similar when performed by CNS or physicians with 12 and 13 mm, respectively. In conclusion, BMEs conducted by motivated CNS and within a structured training program are feasible and yield equal outcomes compared to physicians. The use of adequate pain management during BMEs by trained and experienced operators results in an extremely rare use of sedatives, low pain scores, and high patient satisfaction.

Evaluation of sensitivity and specificity of bone marrow trephine biopsy tests in an Indian teaching hospital

“…This is particularly important in the minimal disease setting and when neuroblastoma detection in bone marrow is intermittent, where clinical impact has yet to be validated. [17][18][19] Acute leukemias are characterized by neoplastic proliferation of hematopoietic stem cells and accumulation of blasts and immature cells in bone marrow. We applied a selective panel of immunohistochemical markers on bone marrow trephine tissue sections and observed their utility in diagnosis and typing of acute leukemia.…”

Trends in Bone Marrow Sampling and Core Biopsy Specimen Adequacy in the United States and Canada

“…This retrospective study analyzing clinical and pathologic aspects of BM sampling and evaluation in 32 academic centers revealed several differences between 2001 and 2011: nonphysician operators increased, suggesting a practice pattern trend as recently reported in the United States and Europe [12][13][14] ; plasma cell neoplasms comprised a greater proportion of clinical indications for BMB specimens, possibly due to improved survival 15 ; and ancillary studies significantly increased while bilateral sampling and usage of heavy metal fixatives decreased.…”

Choosing the Right Therapy for Patients with Relapsed/Refractory Multiple Myeloma (RRMM) in Consideration of Patient-, Disease- and Treatment-Related Factors

“…An additional bone marrow biopsy can be valuable to perform, due to some patients with packed marrow making it difficult to acquire BM aspirates. This may ensure that at least one valid BM assessment is available and BM infiltration can be evaluated, if no aspirate is being obtained or if both show larger discrepancies [16][17][18]. In patients with clear relapse due to an increase in M-protein, detected by serum protein electrophoresis and/or SFLCs and ratio, a bone marrow puncture might be omitted as an individual patient and physician decision [15].…”