AN AUDIT OF LENGTH OF BONE MARROW TREPHINE BIOPSIES AT A TERTIARY CARE HOSPITAL

Authors

  • Saif ur Rehman
  • Lubna Zafar
  • Faiza Kazi
  • Zahur ur Rehman
  • Muhammad Luqman

Abstract

Background: Bone marrow trephine biopsy is a well established minor surgical procedure for the
inspection of bone marrow usually done along with bone marrow aspiration. The objective of this study
was to evaluate the length of trephine biopsies and the rate of positivity for diagnosis as well as unfit
biopsies in various length ranges. Methods: This retrospective study was conducted at Fauji
Foundation Hospital and Foundation University Medical College Rawalpindi from Jan 2007 to Dec
2009. A total of 394 trephine biopsy reports were collected and reviewed. The criterion for adequate
trephine 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 of
trephine 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 positive
diagnosis. Group-2 included 137 biopsies and 133 (97.1%) had positive diagnosis. Group-3 included 99
biopsies and 91 (92%) had positive diagnosis. Group-4 included 70 biopsies and 57 (81.4%) had
positive diagnosis. There was no significant difference between group-1 and group-2 for the rate of
positivity 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. Total
26 trephine biopsies were unfit for evaluation, out of which 13 (50%) belonged to group-4. Trephine
biopsies that were unfit for evaluation were 4 (4.9%) in 2007, 17 (10.5%) in 2008, and 5 (3.3%) in
2009. Conclusion: Although 22.3% biopsies were of recommended length there was no significant
difference in rate of positive diagnosis between biopsies of ‰¥1.5 Cm and 1-1.4 Cm.
Keywords: Audit, Bone marrow trephine biopsy

References

The haematologists should review their technique and

make an attempt to improve adequacy of trephine

biopsy length.

Pathologists should give feedback about inadequacy

of specimen.

The audit should be repeated every year.

J Ayub Med Coll Abbottabad 2010;22(4)

http://www.ayubmed.edu.pk/JAMC/PAST/22-4/Saif.pdf 83

REFERENCES

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

;6:41-4.

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

;59:903-11.

Islam A. Indications for and Value of Bone Marrow Trephine

Biopsy in Haematological Disorders. Hematology

;1:167-72.

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

Anal 2004;18:70-90.

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

Oncol 2003;14:273-6.

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'²s Sarcoma. Saudi Med J

;25:1286-8.

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.

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Published

2010-12-01

How to Cite

Rehman, S. ur, Zafar, L., Kazi, F., Rehman, Z. ur, & Luqman, M. (2010). AN AUDIT OF LENGTH OF BONE MARROW TREPHINE BIOPSIES AT A TERTIARY CARE HOSPITAL. Journal of Ayub Medical College Abbottabad, 22(4), 81–83. Retrieved from https://www.jamc.ayubmed.edu.pk/jamc/index.php/jamc/article/view/2715