Clinical Experience with SNARECOIL™(SC) Bone Marrow(BM) Biopsy(Bx) Needle(N)
Alec S. Goldenberg1* and James J. Tiesinga2*. (Intr. by Tibor Moskovits)
The SC BM Bx N incorporates an internal specimen (sp) capturing device at the N tip. The N was developed both to decrease patient (pt) discomfort by minimizing post insertion N manipulations and to increase the recovery of intact sps. (Goldenberg, A. et al., Biomed Instr & Tech, 1999) Methods:44 pts M/F = 29/15 with a median age of 61.3 underwent 50 BM Bxs using disposable 11G, 4" SC BM Bx Ns (Ranfac Corp., Avon, MA). 39 pts had 1 Bx. 5 had additional Bxs for follow up or staging. After posterior superior iliac crest insertion the SC was activated and the N withdrawn with minimal manipulation. The consistency of the BM was subjectively characterized as soft, firm or hard. The cored sps were measured and evaluated microscopically for diagnostic BM abnormalities or possible pathologic artifacts. Results: A core sp was obtained during 50/50 (100%) of the procedures. The average sp length (L) was 2.10±0.09 cms. 47/50 (94%) of the sps were > 1.5 cm. 21/50 (42%) were > 1.5 and < 2.0 cm, 18/50 (36%) were > 2.0 and < 3.0 cm and 8/50 (16%) were >3.0 cm. 26/50 (52%) of the sps were > 2.0 cm. The mean sp L for M and F was 2.18 cm and 1.94 cm, respectively not statistically different (p=O.23). 9/50 (18%) of the BM sps were soft, 27/50 (54%) firm, and 14/50 (28%) hard. 7/50 (14%) sps separated into 2 components while being recovered, 1/50 (2%) into 3 segments and 42/50 (84%) remained intact. 6/50 (12%),6/50 (12%) and 7/50 (14%) of the sps demonstrated trabecular fragmentation or stacking and minimal loss of BM material, respectively. Some distortion of architecture was demonstrated no more than 1 mm from the end of 18/47 (38%) of the sps where they were grabbed by the SC representing on average 4.7% of the total L of the sp. A pathologic diagnosis was made for each sp. Some portions of the biopsies demonstrated intact regions of non trabeculated non clotted BM not typically seen with conventional Ns. Excessive bleeding or post procedure infections were not observed. No pt complained of significant pain during the steps of sp capture and N withdrawal. Some pts were unaware that the N had been removed. Conclusions: The SC sp-capturing BM Bx N requires minimal post insertion manipulation to reliably recover sps which are generally >1.5 cm, show rare pathologic artifacts and provide adequate material for diagnosis. Sps of at least 2.0 cm are recovered in more than half the procedures. Minimizing manipulations during sp capture and N withdrawal improves pt comfort.
1 Division of Hematology, New York University Medical Center, New York City, NY, 10016;
2 Department of Pathology, New York University Medical Center, New York City, NY, 10016.
