An Audit of the Length of Bone Marrow Trephine Biopsy in Adult Patients: A Cross-sectional Study

Abstract

Introduction: A bone marrow trephine biopsy is a minor surgical procedure used to diagnose various haematological and non haematological diseases, such as leukaemia, multiple myeloma, and parasitic disorders like histoplasmosis and leishmaniasis. It is often performed alongside bone marrow aspiration to gather additional information about cellularity, the arrangement of marrow components, and the presence of focal diseases. According to the World Health Organisation (WHO), the recommended minimum adequate length for a trephine biopsy is ≥1.5 cm (before processing). Aim: To conduct an audit of trephine biopsy lengths and assess their diagnostic utility among adult patients. Materials and Methods: This cross-sectional study analysed all bone marrow biopsies from adult patients received at the Department of Pathology, Christian Medical College and Hospital in Ludhiana, Punjab, India, over a three-year period (January 2019 to December 2021). The biopsies were categorised into three groups based on their length at the time of grossing: Group A (≥1.5 cm), Group B (1-1.4 cm), and Group C (0.5-0.9 cm). The length of each trephine biopsy was recorded and its diagnostic usefulness was evaluated. Results: The study included 1,155 trephine biopsies performed over the three-year period. Out of these, 1042, 97, and 16 biopsies were allocated to Groups A, B, and C, respectively. Biopsies meeting the recommended length (>1.5 cm) accounted for 90.2% of the cases. Longer biopsies were associated with a higher rate of conclusive diagnosis compared to shorter biopsies (p-value=0.02). However, when comparing Groups A and B individually, no significant difference was observed in terms of the conclusive diagnosis (p-value=0.9). Conclusion: Trephine biopsy is a vital tool for diagnosing haematological disorders, particularly focal lesions. Obtaining longer trephine biopsies should be emphasised, as they contribute to a more definitive diagnosis.