AN AUDIT OF LENGTH OF BONE MARROW TREPHINE BIOPSIES AT A TERTIARY CARE HOSPITAL
AbstractBackground: Bone marrow trephine biopsy is a well established minor surgical procedure for theinspection of bone marrow usually done along with bone marrow aspiration. The objective of this studywas to evaluate the length of trephine biopsies and the rate of positivity for diagnosis as well as unfitbiopsies in various length ranges. Methods: This retrospective study was conducted at FaujiFoundation Hospital and Foundation University Medical College Rawalpindi from Jan 2007 to Dec2009. A total of 394 trephine biopsy reports were collected and reviewed. The criterion for adequatetrephine biopsy was ≥1.5 Cm. The biopsies were divided into four groups according to length, i.e.,group-1: ≥1.5 Cm, group-2: 1–1.4 Cm, group-3: 0.5–0.9 Cm, and group-4: <0.5 Cm. The adequacy oftrephine biopsy length and rate of positive diagnosis as well as unfit biopsies were compared. Results:Total 394 trephine biopsies were reviewed. Group-1 included 88 biopsies and 87 (98.9%) had positivediagnosis. Group-2 included 137 biopsies and 133 (97.1%) had positive diagnosis. Group-3 included 99biopsies and 91 (92%) had positive diagnosis. Group-4 included 70 biopsies and 57 (81.4%) hadpositive diagnosis. There was no significant difference between group-1 and group-2 for the rate ofpositivity of diagnosis (p=0.65). In group-1, 1 (1.1%) was unfit for evaluation, in group-2, 4 (2.9%)were unfit, in group-3, 8 (8%) were unfit, and in group-4, 13 (18.5%) were unfit for evaluation. Total26 trephine biopsies were unfit for evaluation, out of which 13 (50%) belonged to group-4. Trephinebiopsies that were unfit for evaluation were 4 (4.9%) in 2007, 17 (10.5%) in 2008, and 5 (3.3%) in2009. Conclusion: Although 22.3% biopsies were of recommended length there was no significantdifference in rate of positive diagnosis between biopsies of ≥1.5 Cm and 1–1.4 Cm.Keywords: Audit, Bone marrow trephine biopsy
The haematologists should review their technique and
make an attempt to improve adequacy of trephine
Pathologists should give feedback about inadequacy
The audit should be repeated every year.
J Ayub Med Coll Abbottabad 2010;22(4)
Ally SH, Ahmed A, Hanif R. An audit of serological test carried
out at clinical laboratory of Ayub Teaching Hospital Abbottabad.
J Ayub Med Coll Abbottabad 2005;17(2):75–8.
Parapia LA. Trepanning or trephines: a history of bone marrow
biopsy. Br J Haematol 2007;139:14–9.
Kumar S, Rau AR, Naik R, Kini H, Mathai AM, Pai MR, et al.
Bone marrow biopsy in non-Hodgkin lymphoma: a
morphological study. Indian J Pathol Microbiol 2009;52:332–8.
Subramanian R, Basu D, Badhe B, Dutta TK. Role of bone
marrow biopsy in the diagnosis of marrow involvement in
Hodgkin’s disease. Indian J Pathol Microbiol 2007;50:640–3.
Hamid GA, Hanbala N. Comparison of bone marrow aspiration
and bone marrow biopsy in neoplastic diseases. Gulf J Oncolog
Bain BJ, Clark DM, Wilkins BS. Bone Marrow Pathology. 4th ed:
London: Wiley-Blackwell Science; 2010.
Naresh KN, Lampert I, Hasserjian R, Lykidis D, Elderfield K,
Horncastle D, et al. Optimal processing of bone marrow
trephine biopsy: the Hammersmith Protocol. J Clin Pathol
Islam A. Indications for and Value of Bone Marrow Trephine
Biopsy in Haematological Disorders. Hematology
Franklin IM, Pritchard J. Detection of bone marrow invasion by
neuroblastoma is improved by sampling at two sites with both
aspirations and trephine biopsies. J Clin Pathol 1983;36:1215–18.
Bashawri L A. Bone marrow examination. Indications and
diagnostic value. Saudi Med J 2002;23:191–6.
Riley RS, Hogan TF, Pavot DR, Forysthe R, Massey D, Smith E,
et al. A pathologist’s perspective on bone marrow aspiration and
biopsy: I. Performing a bone marrow examination. J Clin Lab
Olsen RJ, Chang C, Herrick JL, Zu Y, Ehsan A. Acute leukemia
immunohistochemistry: a systemic diagnostic approach. Arch
Pathol Lab Med 2008;132:462–75.
Bishop PW, McNally K, Harris M. Audit of bone marrow
trephines. J Clin Pathol 1992;45:1105–8.
Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H,
et al. WHO Classification of Tumors of Haemopoietic and
Lymphoid Tissues. 4th ed Lyon: International Agency for
Research on Cancer; 2008.
Charles KS, Winfield DA, Angel C, Goepel J. Audit of bone
marrow aspirates and trephine biopsies in multiple myeloma--a
single centre study. Clin Lab Haematol 2004;26:403–6.
Reid MM, Roald B. Adequacy of bone marrow trephine biopsy
specimens in children. J Clin Pathol 1996;49:226–9.
Campbell JK, Mathews JP, Seymour JF, Wolf MM, Juneia SK.
Optimum trephine length in assessment of bone marrow
involvement in patients with diffuse large cell lymphoma. Ann
Anand M, Kumar R, Panikar N, Karak A. Cartilage in bone
marrow biopsies and purple granular deposits in the biopsy
touch. J Clin Pathol 2003;56:883.
Al-Amoudi S, Owaidah T, AL-Dayel F. Incidence and patterns
of bone marrow involvement in Ewing′s Sarcoma. Saudi Med J
Rudzki Z, Partyla T, Okon K, Stachura J. Adequacy of trephine
bone marrow biopsies: the doctor and the patient make a
difference. Pol J Pathol 2005;56:187–95.
Lawson S, Aston S, Baker L, Fegan CD, Milligan DW. Trained
nurses can obtain satisfactory bone marrow aspirates and trephine
biopsies. J Clin Pathol 1999;52:154–6.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.