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

Merzianu, Mihai; Groman, Adrienne; Hutson, Alan D.; Cotta, Claudiu V.; Brynes, Russell K.; Orazi, Attilio; Reddy, V.; Teruya‐Feldstein, Julie; Amre, Ramila; Balasubramanian, Manjula; Brandao, Guilherme; Cherian, Sindhu; Courville, Elizabeth L.; Czuchlewski, David R.; Fan, Guang; Grier, David D.; Hoehn, Daniela; Inamdar, Kedar; Juskevicius, Ridas; Kaur, Prabhjot; Lazarchick, John; Lewis, Michael R.; Miles, Rodney R.; Myers, Jerome; Nasr, Michel R.; Qureishi, Hina Naushad; Olteanu, Horatiu; Robu, Valentin G.; Salaru, Gratian; Vajpayee, Neerja; Vos, Jeffrey A.; Zhang, Ling; Zhang, Shanxiang; Aye, Le; Brega, Elisa Ferreira; Coad, James E.; Grantham, John T.; Ivelja, Sinisa; McKenna, Robert W.; Sultan, Kieran; Wilding, Gregory E.; Hutchison, Robert; Peterson, LoAnn; Cheney, Richard

doi:10.1093/ajcp/aqy066

Cited by 6 publications

(5 citation statements)

References 56 publications

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“…Cellularity is best evaluated from the biopsy, ideally ≥ 1.5 cm in length without crush artifact 15 ; however, in many practice settings biopsies are usually smaller. 26 Clot sections are suboptimal, but can be used if they have moderately sized spicules ≥ 0.2 cm. Aspirate smears can only give a qualitative estimate.…”

Section: Discussionmentioning

confidence: 99%

Beyond Hemoglobin: When and How to Work Up Possible Polycythemia Vera

Shaw

Berg

2019

Clin Med Res

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Background: World Health Organization (WHO) 2017 diagnostic criteria for hemoglobin levels in polycythemia vera (PV) were lowered from 185 g/L to 165 g/L for men and from 165 g/L to 160 g/L for women, but these cutoffs were not designed for screening. Objectives: The primary aim of this study was to assess the value of laboratory and clinical parameters in deciding whether to further pursue a diagnosis of PV. A secondary aim was to explore the diagnostic utility of bone marrow morphology. Methods: We evaluated clinical and laboratory parameters that may be useful when considering further diagnostic work-up, emphasizing PV vs. secondary erythrocytosis (SE). We classified 200 patients with JAK2 V617F testing using WHO criteria. Results: Patients with myeloproliferative neoplasms (MPN) were rarely under age 40 and uncommonly obese (BMI ≥ 30 kg/m 2). Current smoking history favored SE, and these patients rarely had a platelet count ≥ 450 x 10 3 /uL. Laboratory parameters suggesting greater PV likelihood were: RBC > 6.8 x 10 6 for men or > 5.9 x 10 6 for women; low erythropoietin; and low MCV or low ferritin. Bone marrow morphology (available in 111 cases) was generally more cellular in PV vs. SE and assessed disease progression. Conclusions: Readily accessible clinical and laboratory data can assist in considering a PV workup, and a possible diagnostic algorithm is presented. These preliminary findings warrant larger studies to develop a more formal PV-risk scoring system with optimal cutoffs and weighting.

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Section: Discussionmentioning

confidence: 99%

Beyond Hemoglobin: When and How to Work Up Possible Polycythemia Vera

Shaw

Berg

2019

Clin Med Res

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“…[ 9 10 11 ] In contrast, a recent study of 6374 marrow specimens from 32 academic centers showed only 4% of the bone marrow biopsies and 2% of the bone marrow biopsy/bone marrow aspirate samples inadequate for diagnosis. [ 12 …”

Section: Introductionmentioning

confidence: 99%

“…Synoptic reporting, using standardized checklists and data elements, is widely accepted to improve the accuracy and completeness of pathology reports[ 13 ] and this format has been facilitated by the cancer checklists and guidelines developed by the CAP. [ 12 13 ] Based on the CAP checklist, Murari and Pandey proposed synoptic reporting system for bone marrow specimens, in 2006, and a similar synoptic system for hematological and lymphoid neoplasms was devised by Mohanty et al . [ 14 15 ] Detailed guidelines for the application of the checklist in synoptic bone marrow reporting were subsequently published by the CAP Pathology and Laboratory Quality Center.…”

Section: Introductionmentioning

confidence: 99%

A Synoptic Reporting System to Monitor Bone Marrow Aspirate and Biopsy Quality

Riley

Gandhi²,

Harley

et al. 2021

Journal of Pathology Informatics

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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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“…152 If both marrow cytology and marrow architecture are needed, separate aspiration and core biopsies are recommended. 153,154 Of note, in an extensive survey from 2001 to 2011 of 6374 bone marrow samples in 32 academic centers, adequacy remained a major concern, with adequacy criteria for CNB centered on core biopsy length and capacity for morphologic evaluation. 154 Altogether, 11% of CNBs were noncontributory.…”

Section: Bone Marrowmentioning

confidence: 99%

“…153,154 Of note, in an extensive survey from 2001 to 2011 of 6374 bone marrow samples in 32 academic centers, adequacy remained a major concern, with adequacy criteria for CNB centered on core biopsy length and capacity for morphologic evaluation. 154 Altogether, 11% of CNBs were noncontributory. In part this can be attributed to the observation that on average only 74% of the biopsies contained evaluable bone marrow.…”

Section: Bone Marrowmentioning

confidence: 99%

Needle Biopsy Adequacy in the Era of Precision Medicine and Value-Based Health Care

Pritzker

Nieminen

2019

Archives of Pathology &Amp; Laboratory Medicine

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Context.— Needle biopsy of diseased tissue is an essential diagnostic tool that is becoming even more important as precision medicine develops. However, the capability of this modality to efficiently provide samples adequate for diagnostic and prognostic analysis remains quite limited relative to current diagnostic needs. For physicians and patients, inadequate biopsy frequently leads to diagnostic delay, procedure duplication, or insufficient information about tumor biology leading to delay in treatment; for health systems, this results in substantial incremental costs and inefficient use of scarce specialized diagnostic resources. Objective.— To review current needle biopsy technology, devices, and practice with a perspective to identify current limitations and opportunities for improvement in the context of advancing precision medicine. Data Sources.— PubMed searches of fine-needle aspiration and core needle biopsy devices and similar technologies were made generally, by tissue site, and by adequacy as well as by health economics of these technologies. Conclusions.— Needle biopsy adequacy can be improved by recognizing the importance of this diagnostic tool by promoting common criteria for needle biopsy adequacy; by optimizing needle biopsy procedural technique, technologies, clinical practice, professional education, and quality assurance; and by bundling biopsy procedure costs with downstream diagnostic modalities to provide better accountability and incentives to improve the diagnostic process.

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

Abstract: 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.

Cited by 6 publications

References 56 publications

Beyond Hemoglobin: When and How to Work Up Possible Polycythemia Vera

Beyond Hemoglobin: When and How to Work Up Possible Polycythemia Vera

A Synoptic Reporting System to Monitor Bone Marrow Aspirate and Biopsy Quality

Needle Biopsy Adequacy in the Era of Precision Medicine and Value-Based Health Care

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