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.
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