(P129) Bone Marrow Aspiration Under CT Guidance: Technique and Value

OncologyOncology Vol 29 No 4_Suppl_1
Volume 29
Issue 4_Suppl_1

Bone marrow aspiration under CT guidance is a safe procedure that has become commonplace at our institution. Pain is minimal, even in the absence of sedation. All biopsies performed at our institution with participation from the pathology department have resulted in diagnostic specimens, and relationships with healthcare stakeholders have improved.

Cory Pfeifer, MD, Tyler Ternes, Shannon St. Clair, William Palko, MD, Christopher Dakhil; University of Kansas, Wichita; Lenox Hill Hospital; Wesley Medical Center; Cancer Center of Kansas

PURPOSE: (1) Describe the quality basis for our institution’s transition toward computed tomography (CT)-guided bone marrow aspiration. (2) Identify the equipment and approach used in bone marrow aspiration, as well as its pitfalls. (3) Outline the steps employed at our institution. (4) Emphasize the role of the partnership between radiologists, pathologists, and oncologists in the successful execution of the procedure.

BACKGROUND: The shift toward quality-based health care delivery models has underlined the need to provide accurate diagnoses with as few complications as possible. These changes in our health care structure parallel procedure-complicating factors, such as changes in typical patient body habitus and clinician availability to perform standard bone marrow aspiration. At our institution, radiologists have partnered with oncologists to address these challenges by providing high-quality service with minimal complication rates utilizing CT guidance.

PROCEDURE DETAILS: Standard CT guidance is utilized to localize the bilateral posterior iliac crests, and a posterior technique is employed with the patient in the prone position. We approach the patient from the contralateral side of the iliac target. Our experience has shown that pathologists prefer to supply T-handle twist-type biopsy needles for sampling, as opposed to the hammer-based needle setup. Feedback from the pathology service has suggested that the hammer method results in greater contamination by peripheral blood. Once the marrow cavity is accessed, we aspirate separate marrow aliquots for slide fixation with a histotechnologist at the bedside who prepares the fresh specimens. A sample core is then obtained and preserved separately. Communication with the ordering oncologist is essential for specimen acquisition, as flow cytometric analysis and specific marker assays require disparate bedside preservation techniques. Our stepwise technique will be described pictorially.

CONCLUSION: Bone marrow aspiration under CT guidance is a safe procedure that has become commonplace at our institution. Pain is minimal, even in the absence of sedation. All biopsies performed at our institution with participation from the pathology department have resulted in diagnostic specimens, and relationships with healthcare stakeholders have improved.

Proceedings of the 97th Annual Meeting of the American Radium Society - americanradiumsociety.org

Articles in this issue

(P005) Ultrasensitive PSA Identifies Patients With Organ-Confined Prostate Cancer Requiring Postop Radiotherapy
(P001) Disparities in the Local Management of Breast Cancer in the United States According to Health Insurance Status
(P002) Predictors of CNS Disease in Metastatic Melanoma: Desmoplastic Subtype Associated With Higher Risk
(P003) Identification of Somatic Mutations Using Fine Needle Aspiration: Correlation With Clinical Outcomes in Patients With Locally Advanced Pancreatic Cancer
(P004) A Retrospective Study to Assess Disparities in the Utilization of Intensity-Modulated Radiotherapy (IMRT) and Proton Therapy (PT) in the Treatment of Prostate Cancer (PCa)
(S001) Tumor Control and Toxicity Outcomes for Head and Neck Cancer Patients Re-Treated With Intensity-Modulated Radiation Therapy (IMRT)-A Fifteen-Year Experience
(S003) Weekly IGRT Volumetric Response Analysis as a Predictive Tool for Locoregional Control in Head and Neck Cancer Radiotherapy 
(S004) Combination of Radiotherapy and Cetuximab for Aggressive, High-Risk Cutaneous Squamous Cell Cancer of the Head and Neck: A Propensity Score Analysis
(S005) Radiotherapy for Carcinoma of the Hypopharynx Over Five Decades: Experience at a Single Institution
(S002) Prognostic Value of Intraradiation Treatment FDG-PET Parameters in Locally Advanced Oropharyngeal Cancer
(P006) The Role of Sequential Imaging in Cervical Cancer Management
(P008) Pretreatment FDG Uptake of Nontarget Lung Tissue Correlates With Symptomatic Pneumonitis Following Stereotactic Ablative Radiotherapy (SABR)
(P009) Monte Carlo Dosimetry Evaluation of Lung Stereotactic Body Radiosurgery
(P010) Stereotactic Body Radiotherapy for Treatment of Adrenal Gland Metastasis: Toxicity, Outcomes, and Patterns of Failure
(P011) Stereotactic Radiosurgery and BRAF Inhibitor Therapy for Melanoma Brain Metastases Is Associated With Increased Risk for Radiation Necrosis
Related Videos
An expert from Dana-Farber Cancer Institute indicates that patients with prostate cancer who have 1 risk factor should undergo salvage radiotherapy following radical prostatectomy before their prostate-specific antigen level rises above 0.25 ng/ml.
An expert from Weill Cornell Medicine highlights key clinical data indicating the benefits of radium-223 in the treatment of patients with metastatic castration-resistant prostate cancer.
The risk of radionuclide exposure to the public reflects one reason urologists need to collaborate with radiation oncologists when administering radiopharmaceuticals to patients with prostate cancer.
Switching out beta emitters for alpha emitters, including radium-223, is one way to improve radiopharmaceutical treatment of prostate cancer, according to an expert from Weill Cornell Medicine.
Data demonstrate the feasibility of automated glomerular filtration rate prediction to decide between partial nephrectomy and radical nephrectomy in kidney cancer, according to an expert from the Cleveland Clinic.
Early phase trials investigating cellular therapies, bispecific antibodies, and antibody-drug conjugates for refractory kidney cancer may uncover strategies to overcome resistance mechanisms.
Increasing cancer antigen presentation as well as working with tumor cells in and delivering novel cells to the microenvironment may help in overcoming mechanisms of immune checkpoint inhibitor resistance in refractory renal cell carcinoma.
Lenvatinib plus pembrolizumab appears to be the best option for patients with refractory metastatic renal cell carcinoma who are progressing on immunotherapy combinations or are lenvatinib naïve.
Ipilimumab monotherapy does not appear effective in driving complete responses in refractory renal cell carcinoma despite yielding some progression-free survival intervals, according to an expert from the University of Texas Southwestern Medical Center.
An expert from the University of Texas Southwestern Medical Center discusses several phase 3 clinical trials supporting the use of various single-agent and combination immunotherapy regimens for advanced kidney cancer.
Related Content