Evaluating bone marrow sample quality derived using a non-redirection versus a traditional bone marrow aspiration and biopsy technique Free

Background:The traditional bone marrow aspiration and biopsy technique involves the insertion of the biopsy needle once to obtain an aspirate followed by a second needle insertion with redirection into the bone to obtain the core biopsy. A non-redirection technique requires a single-time insertion and puncture into the bone. The core biopsy can be extracted with a cradle and then the aspirate can be obtained without needle redirection. Our study aims to evaluate the quality of the bone marrow aspirate and bone marrow biopsy samples obtained through a non-redirection technique versus the traditional biopsy technique.

Methods: This is a single center retrospective cohort study at the University of Michigan Medical Center. Patients 18 years or older with either acute leukemia (including myeloid and lymphoid), myelodysplastic syndromes (including overlap syndromes), or chronic myeloid leukemia as defined by the World Health Organization 2022 criteria with bone marrow biopsies completed with the non-redirection technique or the traditional technique between 2022-2023 were reviewed using the electronic health record. Samples assessing for aplasia after induction chemotherapy were excluded. Cohorts were assigned based on whether a patient received an aspirate and biopsy via the non-redirection versus the traditional technique. Cohorts were segregated independently based on the provider performing the procedure. Demographic data extracted included date of birth, age at time of procedure, biological sex, and diagnosis. Data pertaining to the quality of the bone marrow biopsy sample include adequacy and size of the core biopsy, adequacy of the aspirate, presence of hemorrhagic artifact, and presence of hemodilution in the aspirate. The primary outcome was the composite endpoint of sample adequacy defined as the rate of samples that were reported as containing adequate aspirates or adequate core biopsies. Secondary outcomes include the individual components of the composite endpoint, core biopsy size, presence of aspiration or hemorrhage artifact, and rates of immediate post-procedural complications.

Results:The study population consisted of 139 patients in the traditional technique cohort and 138 patients in the non-redirection technique cohort. The rate of samples containing either an adequate core biopsy or adequate aspirate was 75.2% using the traditional method and 88.4% using the non-redirection method (p=0.005). The rate of adequate core biopsies for the respective cohorts were 47.5% and 72.5% (p= <0.001), and the rate of adequate aspirate smears were 57.6% and 60.1% respectively (p=0.608). There was no statistical difference between the rate of the presence of hemorrhage artifact, aspirate artifact, or immediate post-procedural complications between the two different biopsy methods. The median core size for the traditional method was 0.9 cm compared to 1.1 cm with the non-redirection method (p=0.003).

Conclusions: The non-redirection technique was more likely to result in obtaining a sample with either an adequate core biopsy or aspirate. This was most likely driven by a higher rate of adequate core biopsies in the non-redirection technique compared to the traditional. This is clinically significant, for every eight bone marrow biopsy procedures performed with the non-redirection method, there is one more adequate marrow predicted (as defined by the composite) than using the traditional method. Future studies could explore the benefits of the non-redirection technique regarding patient satisfaction and post-procedural pain. These results support exploration of the non-redirection technique for additional quality endpoints and could potentially be practice changing for providers performing bone marrow biopsies. Recent changes in access to bone marrow biopsy needles that provide adequate cradles for the non-redirection technique may limit the future benefits of this approach.