The Lab as a Driver of Quality in the Preanalytical Realm: The Case of Technologist-Assisted Bone Marrow Biopsies

This is the authors' abstract. We don't add key points for this paper.

Pathologic examination of bone marrow is the definitive diagnostic procedure for hematopoietic disorders, both benign and malignant. For many patients, it is the final step in identifying previously elusive disorders.1,2 The modern bone marrow diagnostic process involves a combination of morphologic, immunohistochemical, flow cytometric, and cytogenetic/molecular analyses to arrive at a final diagnosis.3 The morphologic evaluation of bone marrow consists of several components, all of which provide complementary information that is integrated with peripheral blood smear review and ancillary studies to formulate a comprehensive interpretation: (1) bone marrow aspirate smears, (2) trephine biopsy, (3) trephine biopsy touch imprints, and (4) particle/clot sections.4 Aspirate smears and touch imprints allow for high-power cytologic examination, facilitating evaluation of dysplasia, intracellular inclusions, parasites, blast morphology, and various changes associated with other specific disorders.4 This detailed cytologic evaluation is critical for the morphologic diagnosis of hematopoietic neoplasms, such as myelodysplastic syndromes and some types of acute leukemia in which the immature cells may not be accurately quantified by immunohistochemistry or flow cytometry. The trephine biopsy is most useful for assessing architectural changes, fibrosis, and cellularity as well as for identifying focal lesions, such as lymphoid aggregates or metastatic disease. The clot section has similar properties to the trephine biopsy, with the exception that bone is not included. Therefore, in the absence of liquid aspirate for ancillary studies, the clot section may be a suitable replacement for some molecular or fluorescence in situ hybridization studies because it has not undergone decalcification.