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Feasibility and safety of targeting the anterior superior iliac spine to perform a bone marrow procedure: a prospective, clinical study
  1. Loius J Reed1,
  2. Shirin Attarian2,3,
  3. Todd R Olson4,
  4. Shashi Singh5,
  5. Alexander Shestopalov5,
  6. Ellen W Friedman6
  1. 1 Department of Oncology, Jacobi Medical Center, Bronx, New York, USA
  2. 2 Division of Oncology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
  3. 3 Northwell Health, Monter Cancer Center, Lake Success, New York, USA
  4. 4 Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, New York, USA
  5. 5 Department of Radiology, Jacobi Medical Center, Bronx, New York, USA
  6. 6 Division of Hematology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
  1. Correspondence to Dr Shirin Attarian, Department of Oncology, Northwell Health, Monter Cancer Center, 450 Lakeville Road, Lake Success, NY 11042, USA; sattarian{at}northwell.edu

Abstract

Aims The bone marrow procedure (BMP) has been performed worldwide for years. Nonetheless, no generally accepted standards or guidelines for the performance of the BMP exist. Recent studies suggested that the lateral angulation technique (LAT), targeting the anterior superior iliac spine (ASIS) after penetration of the posterior superior iliac spine, yields longer biopsy cores and is safer for patients. We assessed the feasibility and safety of targeting the ASIS in the prone and lateral decubitus positions.

Methods We first observed the BMP needle tracks on cadavers. Our cadaver study revealed that the LAT is feasible and safe but requires different operator techniques. Next, we studied 25 adult haematology patients undergoing elective BMP via the LAT approach. Patients returned 5 days after the BMP for a haemoglobin assessment, pain questionnaire and low-dose non-contract CT.

Results 8% of patients reported persistent pain. No fall in haemoglobin and no pelvic haematomas or neurovascular injuries were detected. 88% of BMPs were successfully accomplished by targeting the ASIS. 12% required a back-up traditional angulation technique (TAT), directing the needle straight in, perpendicular to the coronal plane of the back. All three demonstrated inadvertent, but asymptomatic, penetration of the sacrum. Biopsy lengths were compared with a historical TAT control demonstrating that specimens obtained by LAT are significantly longer. Imaging studies showed that a seven-degree change in needle direction can convert a TAT to a LAT.

Conclusion The LAT approach is feasible, safe and more productive than the TAT, and may be the preferred standard for training haematologists.

Trial registration number NCT02524613.

  • bone marrow biopsy
  • bone marrow procedure.
  • Haematology

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Footnotes

  • Handling editor Mary Frances McMullin.

  • Contributors LJR and EWF planned the concept and design. LJR and EWF developed the methodology. SA, TRO, SS and AS acquired the data. LJR, SA and EWF analysed and interpreted the data. LJR, SA and EWF wrote, reviewed and/or revised the manuscript. LJR was responsible for study supervision.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval IRB, Jacobi Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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