Improving the quality of bone marrow assessment: Impact of operator techniques and use of a specimen preparation checklist.
BACKGROUND
Successful bone marrow assessment is essential to the diagnosis and staging of hematologic malignancies. The objective of this study was to determine whether specific operator techniques and/or use of a specimen preparation checklist could impact the quality of bone marrow assessment by reducing the frequency of nonspicular aspirates, small cores, and nondiagnostic samples.


METHODS
All bone marrow biopsies performed at the Dana-Farber Cancer Institute from April, 2012 to September, 2012 were eligible for inclusion. Six operator techniques were linked with specimen quality in a preintervention cohort. Next, a specimen preparation checklist was implemented, and outcomes were compared from the preintervention and postintervention cohorts.


RESULTS
In total, 830 procedures performed by 41 operators were prospectively observed and analyzed. In the preintervention cohort (n = 413), no operator technique was associated with specimen quality in multivariable models accounting for patient characteristics and operator. Compared with the preintervention cohort, in multivariable analyses, the postintervention cohort (n = 417) had decreased odds of nondiagnostic specimens (odds ratio, 0.49; 95% confidence interval, 0.28-0.87; P = .01) and core lengths ≤1 cm (odds ratio, 0.67; 95% confidence interval, 0.50-0.90; P = .009), but there was no significant difference in spicularity.


CONCLUSIONS
Variation in the operator techniques studied did not have an impact on specimen quality, but implementation of a specimen preparation checklist significantly improved core length and frequency of diagnostic samples.
Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Oreofe O
OO
Odejide
Angel M
AM
Cronin
Daniel J
DJ
DeAngelo
Zachary A
ZA
Bernazzoli
Joseph O
JO
Jacobson
Scott J
SJ
Rodig
Ann S
AS
LaCasce
Teresa J
TJ
Mazeika
Kristofer D
KD
Earles
Gregory A
GA
Abel
D044963:Biopsy, Fine-Needle / Q000379:methods; D001854:Bone Marrow Cells / Q000166:cytology* / Q000473:pathology; D001856:Bone Marrow Examination / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D013048:Specimen Handling / Q000295:instrumentation / Q000379:methods* / Q000592:standards
bone marrow aspiration; bone marrow biopsy; leukemia; lymphoma