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Effects of the Use of a Mallet during Bone Marrow Biopsy Collection on Specimen Quality: A Quality Improvement

Shakuntala H Mauzo1, Natalia Golardi1, Aaron J Baxter2

  • 1Department of Pathology and Laboratory Medicine, University of Texas McGovern Medical School at Houston, Houston, Texas, USA.

Annals of Clinical and Laboratory Science
|August 26, 2018
PubMed
Abstract

Insights

Using a mallet during bone marrow biopsy significantly harms specimen quality, causing fragmentation and inadequate samples. This technique should be avoided to ensure accurate bone marrow diagnosis.

Area of Science:

  • Pathology
  • Interventional Radiology
  • Hematology

Background:

  • Accurate bone marrow diagnosis relies on preserving specimen morphology, avoiding fragmentation and crush artifacts.
  • The use of a hammer or mallet to advance biopsy needles, though infrequent, is a known technique.

Purpose of the Study:

  • To assess the impact of using a mallet on bone marrow biopsy specimen quality.
  • To evaluate the association between mallet use and morphologic distortion in bone marrow samples.

Main Methods:

  • A retrospective review of 93 bone marrow core biopsy specimens was conducted.
  • Specimens were analyzed for crush artifact, fragmentation, aspiration artifact, osteopenia, and overall adequacy.
  • Data was compared between biopsies where a mallet was used and those where it was not.

Main Results:

  • Mallet use occurred in 29 of 93 cases and was significantly associated with suboptimal specimen quality (p<0.005).
  • Mallet use was independently linked to severe specimen fragmentation (p<0.0001).
  • No significant association was found between mallet use and core biopsy length.

Conclusions:

  • Mallet use during bone marrow core biopsy collection significantly increases morphologic distortion, particularly severe fragmentation.
  • This technique negatively impacts specimen adequacy and should be avoided.
  • Contrary to prior assumptions, mallet use does not improve core biopsy length.
Keywords:
Boneartifactfragmentationmalletmarrow

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