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Targeting the anterior superior iliac spine yields significantly longer bone marrow cores
  1. Louis Reed1,
  2. Shirin Attarian1,2,
  3. Gopichand Pendurti1,
  4. Aditi P Singh1,2,
  5. Anjali Budhathoki1,2,
  6. Simon Abi-Aad1,2,
  7. Urvi A Shah1,2,
  8. Salem Kim1,2,
  9. Kimo Bachiashvili1,2,
  10. Jee Young Moon3,
  11. Mimi Kim3,
  12. Tarek Elrafei1,
  13. Karenza Alexis1,
  14. Marianna Strakhan1,
  15. Weijuan Li1,
  16. Ellen Friedman2
  1. 1 Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
  2. 2 Department of Hematology and Oncology, Montefiore Medical Center, Bronx, New York, USA
  3. 3 Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
  1. Correspondence to Dr Shirin Attarian, Department of Hematology and Oncology, Montefiore Medical Center, 111 East 210th Street, Hofheimer Building, 2nd floor, Bronx, NY 718-920-4826, USA; sattaria{at}


Pathologists and haematologists generally agree that the length of the biopsy core is a good surrogate for the diagnostic quality of the bone marrow. Previous studies suggested that the angulation of the biopsy needle from the posterior superior iliac spine (PSIS) could influence the length of the biopsy cores, targeting the anterior superior iliac spine (ASIS) from the PSIS would yield longer specimens than the traditional angulation technique (TAT), where the biopsy needle is directed straight in, perpendicular to the plane of the back. Twenty five adult haematology patients were prospectively recruited by haematologists-in-training (HITs), who were trained to target the ASIS using a lateral angulationtechnique (LAT). The mean length of biopsy cores was 16 mm and that was significantly longer (p=0.003) than a comparable group of bone marrow biopsies previously obtained by HITs using the TAT approach. These results support the LAT as a new standard of haematology practice.

Trial registration number NCT 02524613

  • bone marrow
  • hematopathology
  • bone marrow trephines

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  • Handling editor Mary Frances McMullin.

  • Contributors LR, EF, GP, WL, MS, KA and TE planned the concept and design. LR, WL and EF developed the methodology. SA, APS, AB, SA-A, UAS, SK and KB acquired the data. LR, SA, EF, GP, MK and JYM analysed and interpreted the data. LR, SA, EF and GP wrote, reviewed and/or revised the manuscript. LR, GP, KA, TE and MS were responsible for study supervision.

  • Competing interests None declared.

  • Ethics approval Institutional Review Board for Jacobi Medical Center/Albert Einstein College of Medicine.

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