Comparison of a Rotary Powered Bone Marrow Aspiration and Biopsy Device to the Traditional Manual Device in an Adolescent

Abstract 4718

Bone marrow examination is important for the diagnosis of hematological malignancies and nonmalignant diseases in children. In patients with newly diagnosed lymphoproliferative diseases and certain non-hematopoietic malignancies, bone marrow examination is also part of the staging process. Core biopsy length has been found to be critical in diagnosing, predicting relapse or identifying residual disease following chemotherapy in patients. The larger the amount of marrow obtained increases the chance of finding a focal lesion. Unfortunately, the current practice of obtaining trephine biopsies and bone marrow aspirates in children via the manual method has a poor success rate for obtaining adequate specimens. In 2007, an FDA-cleared battery powered bone marrow aspiration and biopsy system (OnControl™ by Vidacare) was developed. Multiple studies have evaluated the use of the powered device in adults and found decreased time of procedure, decreased pain, and improved core biopsy specimens.

Here we present a direct comparison of the rotary powered device versus the traditional manual device (e.g. Jamshidi) when obtaining bilateral bone marrow aspirates and biopsies in a 17 year-old female with relapsed alveolar rhabdomyosarcoma. This patient required bilateral bone marrow biopsies to stage her disease and evaluate for bone marrow involvement. One aspirate and biopsy was obtained using the powered device from the right posterior superior iliac crest, and specimens were obtained from the left iliac crest using the traditional manual device. The endpoints measured were quality of the biopsy, length and width of the biopsy, time to obtain aspirate and biopsy, number of attempts to obtain the biopsy, post-procedural pain, and operator satisfaction with the device (O.S.).

In conclusion, the powered device was superior to the manual device in terms of time to obtain the aspirate and biopsy and operator satisfaction with the device. It was found to be equivalent to the manual device in regards to number of attempts to obtain the biopsy, and post-procedural pain score. The manual device produced a biopsy that was longer, wider, and of higher quality than the biopsy obtained via the powered method. A randomized controlled trial in the pediatric population comparing the rotary powered device to the traditional device is currently underway as further studies are needed to evaluate the use of the powered bone marrow aspiration and biopsy device in children.