Bone Marrow Aspiration And Biopsy Research Articles

WBC Count and WBC to Hb Ratio Could Predict Short-Term Recurrence Rate in Multiple Myeloma Patients Underwent Autologous Stem Cell Transplantation

Multiple myeloma (MM) is a hematologic malignancy with a variable clinical course. We investigated the prognostic role of routine laboratory factors including CBC indices and serum vitamin D levels to predict MM recurrence after receiving an autologous stem cell transplant (ASCT). 29 patients were enrolled. Before ASCT, demographic data and CBC, serum Cr, and Vit D levels were obtained. Patients underwent bone marrow aspiration (BMA) and biopsy (BMB) before ASCT and pretransplant plasma cell counts were also evaluated. Patients were followed for 6 months and BMA and biopsy were done in the 3rd and 6th month of the follow-up to detect recurrence. Overall, 9 patients were reported to have recurrence. The patient's WBC count mean was 13.3±11.6. WBC count was lower in patients with overall recurrence (P=0.005). Patients were divided into 2 groups according to WBC count (<5.5 109/L and ≥5.5 109/L) and we found that WBC count <5.5 109/L was associated with increased risk of recurrence by 15.2 times (Odds ratio: 15.2, 95%CI: 1.4-168, P=0.005). We also evaluated Wbc to Hb ratio (Wbc/Hb) and found that Wbc/Hb <1 had a significant statistical relationship with overall recurrence (P=0.026) as patients with WBC/Hb <1 were in 9.8 times increased risk of recurrence (Odds ratio:9.8, 95% CI: 2-93.5, P=0.026). pretransplant WBC <5.5 109/L and WBC/Hb <1 were associated with 9.8 and 15.2 times increased risk of myeloma recurrence and could be useful predictive factors for a patient's short-term recurrence.

The Effect of Video Streaming With Virtual Reality on Anxiety and Pain During Bone Marrow Aspiration and Biopsy Procedure

BackgroundPain and anxiety are among the most common symptoms in patients undergoing invasive procedures. Increased pain levels tend to worsen anxiety, and anxiety often leads to more frequent or severe pain. AimsThe study was conducted to determine the efficacy of virtual reality goggles (VRG) on pain and anxiety during bone marrow aspiration and biopsy (BMAB) procedure. DesignA randomized controlled experimental study. SettingsThe outpatient unit of an adult hematology clinic of a tertiary care university hospital. Participants/SubjectsThe study was conducted in patients aged 18 years and older who underwent a BMAB procedure. Thirty-five patients in the experimental (VRG) group and 40 patients in the control group. MethodsPatient identification form, visual analogue scale (VAS), state and trait anxiety inventory (STAI), and VRG were used to collect the data. ResultsPostprocedural state anxiety mean scores were found to be statistically significantly higher in the control group than in the VRG group (p = .022). A statistically significant difference was found between groups in terms of procedure-related pain (p = .002). The postprocedural mean pain scores were found to be statistically significantly higher in the control group than in the VRG group (p < .001). A statistically significant but moderate positive correlation was found between the postprocedural pain and preprocedural state anxiety variable (r = 0.477). A statistically significant and strong positive correlation was found between the postprocedural pain and the postprocedural state anxiety variable (r = 0.657). A statistically significant but moderate positive relationship was found between preprocedural and postprocedural state anxiety variables (r = 0.519). ConclusionsWe determined that video streaming with VRG reduces pain and anxiety felt by adult patients during the BMAB procedure. VRG can be recommended to use in controlling pain and anxiety in patients undergoing a BMAB procedure.

Is Bone Marrow Aspiration and Biopsy of Clinical Importance in the Initial Staging of Extraskeletal Ewing Sarcoma?

Extraskeletal Ewing sarcoma are rare tumors within the Ewing sarcoma family. Initial staging studies for extraskeletal Ewing sarcoma historically have included imaging and bone marrow aspiration and biopsy (BMAB). However, recent studies on Ewing sarcoma of bone have questioned the utility of BMAB in the initial staging of patients, but no studies of which we are aware have evaluated the role of BMAB in extraskeletal Ewing sarcoma. We suspected that BMAB was of low diagnostic yield in patients with extraskeletal Ewing sarcoma and exposed patients to potential morbidity without an impact on their clinical course. Is BMAB a useful test in the staging of extraskeletal Ewing sarcoma? Between January 1996 and December 2021, our institution evaluated 109 patients with a listed diagnosis of extraskeletal Ewing sarcoma. Those patients were retrospectively reviewed for this study. Of those, we considered patients with biopsy-confirmed diagnosis of extraskeletal Ewing sarcoma. Biopsy was performed based on institutional protocols, with all diagnoses assigned by a board-certified pathologist. Based on that criteria, 96% (105 of 109) were eligible. An additional 18% (20 of 109) were excluded because records of their initial diagnostic and staging workup were not available. This left 78% (85 of 109) for analysis. Of those, 52% (44 of 85) were male. The average age was 32 ± 16 years. Primary tumor locations included extremities in 26% (22 of 85), paraspinal in 20% (17 of 85), chest in 19% (16 of 85), retroperitoneum in 13% (11 of 85), intraabdominal in 12% (10 of 85), intrapelvic in 7% (6 of 85), and head or neck in 4% (3 of 85). Initial diagnostic and staging information, including the use of PET-CT, bone scan, CT chest, and BMAB, was collected. Metastatic disease at the time of presentation or during follow-up was noted. The utility of BMAB was determined by the rate of positive tests in those undergoing BMAB during the initial staging process. Descriptive statistical analysis was sufficient to address the study question, and therefore no comparative statistics were performed. BMAB was obtained during the initial staging process in 64% (54 of 85) of patients. This BMAB was negative in all 54 patients, including those with known metastatic disease. Diagnosing metastatic disease in extraskeletal Ewing sarcoma is important as the presence of metastases at diagnosis adversely affects prognosis. The routine use of BMAB in the staging process of extraskeletal Ewing sarcoma is of low diagnostic yield. BMAB is unlikely to diagnose metastatic involvement even in patients with known metastases to bone. We do not have enough data to suggest whether other modalities, such as PET-CT, might be more useful. Similar studies should be pursued to determine the utility of the remainder of staging modalities in patients with extraskeletal Ewing sarcoma to elucidate the most efficient and effective staging protocol. Level III, diagnostic study.

Staging of newly diagnosed Ewing sarcoma: Results of bone marrow aspiration and biopsy versus (18)FDG-PET/CT imaging for bone marrow involvement

BackgroundEwing sarcoma (ES) is an aggressive bone or extraosseous tumour with an unfavourable prognosis when bone marrow metastases are present at diagnosis. The gold standard diagnosis for bone marrow (BM) involvement is cytological and pathological analysis through bone marrow aspiration and biopsy (BMAB). Several recent studies suggest that these invasive and painful procedures could be replaced by 18F-fluorodeoxyglucose-positron emission tomography/computed tomography ((18)FDG-PET/CT), as this nuclear imaging technique is highly sensitive at detecting bone and extraosseous metastases of ES. MethodsIn order to study the precision of (18)FDG-PET/CT in the evaluation of bone marrow metastases at diagnosis, we compared the imaging results with cytological/histological analyses performed on BM samples. We retrospectively studied 180 patients with ES recorded at the Léon Bérard Centre over the past 10 years, who were evaluated by (18)FDG-PET/CT and BMAB at diagnosis. ResultsOf the 180 patients, 13 displayed marrow metastases by cytological/histological examination, and only one of these did not have (18)FDG-PET/CT signs of bone marrow involvement, whereas the 167 remaining patients without marrow metastasis all had a negative (18)FDG-PET/CT, except for one. Hence, the sensitivity and specificity of (18)FDG-PET/CT in these patients was 92.3% and 99.4%, respectively. The overall survival at five years of all patients was 67.4% but decrease to 38.5% in the group with bone marrow metastases. ConclusionGiven the results presented herein the bone sarcoma group of the French Sarcoma Group suggests that invasive BMAB no longer be systematically performed for the staging at the diagnosis of ES.

Procedural Pain and Serious Adverse Events Following Bone Marrow Aspiration and Biopsy: Analysis from an Academic Center in India

Background: The Bone Marrow Aspiration and Biopsy (BMAB) is an important and frequent investigative procedure for hematological diseases. Although thought to be safe and well tolerated; data is limited on the complications and degree of pain experienced by patients undergoing BMAB. Further scarce is data from India and other regions from the developing world especially given the evidence that cultural factors that could shape pain perception. Adverse events following bone marrow biopsy are rare but poorly documented. Aims: To estimate the level of pain and frequency of serious adverse events experienced by patients undergoing BMAB at our center. We also attempted to identify factors associated with increased pain perception. Study Setting: This study was conducted at a tertiary level teaching hospital, the Christian Medical College &amp; Hospital, Ludhiana. Ethics approval was obtained from the Institutional research committee (CMC/1495). Study Period: 01 April 2015 through 30 Nov 2019 Study Design: This is a comparative cross sectional study where comparison of those with relatively more pain to those with less was done to elicit the factors associated with pain perception. Results: A total of 942 BMAB procedures were performed in this period (Table 1). The major serious adverse event was hemorrhage, which comprised 2 of the 9 serious adverse events. Those with prior BMAB had very low odds of pain (OR (95% CI): 0.23 (0.15–0.37)). However, when more than one attempt of biopsy was made the odds of pain was much higher (OR (95% CI): 1.62 (1.29–2.05)).

A study of patient-reported pain during bone marrow aspiration and biopsy using local anesthesia alone compared with local anesthesia with intravenous midazolam coadministration at a tertiary academic hospital in South Africa.

During the bone marrow aspiration and biopsy (BMAB) procedure, patients report pain of widely variable intensity. There is limited literature on the factors associated with the pain. The use of local anesthesia (LA) only is still widespread although it does not abolish the pain. Midazolam is the most commonly used benzodiazepine for conscious sedation. Our center introduced universal midazolam sedation unless there is a contraindication to its use, 4 years ago. This study assessed the impact of the universal use of intravenous midazolam for BMAB compared to use of LA only. The factors associated with the pain of BMAB, were analyzed. A retrospective cross-sectional study was performed on adult patients who had a BMAB procedure from July 1, 2018 to March 30, 2019. A questionnaire incorporating a visual analog pain scale, was used for data collection. A total of 182 BMAB procedures were included in the study. Pain was reported in all procedures performed under LA and only in 29.1% of procedures performed with midazolam. Age, sex, race, level of education, body mass index (BMI), indication and diagnosis had no influence on pain. Patients who had previous BMAB experienced less pain. Experience of operator had a significant effect on pain. Midazolam dose showed a negative correlation with pain. LA only is not enough to abolish pain of BMAB. Midazolam conscious sedation used with LA reduces pain to acceptable levels. Patients with previous experience of BMAB under midazolam premedication reported less pain. Furthermore, the experience of operator reduced the pain significantly.

Effect of Classical Turkish Music on Pain and Anxiety of Patients undergoing Bone Marrow Aspiration and Biopsy: A Randomized Controlled Clinical Trial

Introduction: Bone Marrow Aspiration and Biopsy (BMAB) is a painful procedure that can causes anxiety in patients. Music can help reduce pain and anxiety levels in patients by directing their attention from negative stimuli towards pleasant and encouraging thoughts. Objective: This study aims to determine the effect of classical Turkish music on pain and anxiety of patients undergoing BMAB. Materials and Methods: This is a randomized, controlled trial conducted on 68 patients undergoing BMAB who were selected from the hematology outpatient clinics in a hospital in İzmir, western Turkey. They were randomly divided into two groups of control (n=34) who received the general procedure only and the music group (n=34) who listened to classical Turkish music for 15 minutes before the procedure. Data were collected using a demographic form, Visual Analogue Scale (VAS), and State Anxiety subscale of Spielberger’s State-Trait Anxiety Inventory. Chi-square was used for comparing categorical variables, and t-test and ANOVA ​​were used for comparing numerical variables. Bonferroni test was used for post hoc comparisons. A P&lt;0.05 statistically significant. In case of a significant difference between the groups, Cohen’s d effect size was calculated. Results: In the music group (Mean±SD age=63.73±14.81 years), 62% were male, 71% were married, 76% had a secondary education or lower, and 49.1% reported that biopsy was for diagnostic purposes. In the control group (Mean±SD age=51.76±19.45 years), 50% were female, 53% were married, 62% had a secondary education or lower, and 50.9% reported that biopsy was for diagnostic purposes. A statistically significant difference was found in the mean VAS scores of both groups before and after the treatment (P=0.001). A significant difference was found in the state anxiety level only in the music group before and after the treatment (P=0.003). Conclusion: Classical Turkish music prior to BMAB can reduce the pain and anxiety of patients. It is recommended for nurses to use music therapy to reduce the pain and anxiety of patients undergoing BMAB.

PB2341: MIDAZOLAM AND LOCAL ANAESTHESIA CO-ADMINISTRATION GIVES BETTER PAIN CONTROL DURING THE BONE MARROW ASPIRATION AND BIOPSY PROCEDURE

Background: During the bone marrow aspiration and biopsy (BMAB) procedure, patients report pain of varying intensity ranging from complete absence of pain to severe pain. There is limited literature on the patient and procedure related factors associated with the pain. Furthermore, evidence-based guidelines on the best method of pain management during BMAB are lacking. The use of local anaesthesia(LA) only is still widespread although it does not abolish the pain of BMAB. Conscious sedation, other pharmacological agents and non-pharmacological interventions are used to a variable extent. Midazolam is the most commonly used benzodiazepine for conscious sedation and may be used in conjunction with local anaesthesia, other systemic pharmacological agents or as a single agent. Our centre introduced universal midazolam sedation unless there is a contraindication to its use, 4 years ago. Aims: To assess the impact of the universal use of intravenous midazolam premedication for the BMAB procedure compared to the use of local anaesthesia only and to determine the patient- and procedure-related factors associated with the patient-reported pain. Methods: A retrospective cross-sectional study was performed on adult patients who had a BMAB in a day procedure operating theatre over the period from 1st July 2018 to 30th March 2019. Patient demographics, the body mass index (BMI), indications, diagnosis, the number of times the patient had the BMAB procedure and the experience of the operator were documented. A numerical rating scale pain assessment tool and questionnaire were used in interviews conducted by the principal investigator. Further data were extracted from the National Health Laboratory Service laboratory information system, patients’ hospital files and the operating theatre records. Results: A total of 182 BMAB procedures were included in the study; 155 procedures performed with midazolam premedication and 27 performed using local anaesthesia only. Pain was reported in all procedures performed under local anaesthesia and only in 29.1% of procedures performed with midazolam administration. Our study showed no influence of age, sex, race, level of educations, indication, diagnosis, experience of the operator on pain. Patients who had previous BMAB experienced less pain. Midazolam dose showed negative correlation with pain. Summary/Conclusion: Local anaesthesia only is not enough to abolish pain of BMAB. Midazolam conscious sedation used with local anaesthesia consistently reduces the reported pain to acceptable levels. Patients with previous experience of BMAB under midazolam premedication reported less pain. The universal use of midazolam conscious sedation for BMAB under carefully controlled circumstances is strongly recommended.

Bone marrow aspiration and biopsy: techniques and practice implications

Bone marrow aspiration and biopsy (BMAB) is a valuable diagnostic procedure commonly performed for evaluation of a wide spectrum of diseases including hematologic abnormalities, nonhematologic malignancies, metabolic abnormalities, and tumor treatment response such as chemotherapy and bone marrow transplantation, hematologic tumor staging, and suspected infection in patients with fever of unknown origin. This minimally invasive intervention offers excellent safety profile and a high diagnostic yield. Radiologists should be familiar with clinical implications of BMAB for patient care and be able to implement various technical armamentarium available to achieve a safe intervention while maximizing procedure yield.

Type and level of anxiety affects the perception of pain during bone marrow biopsy

Objective: Bone marrow aspiration and biopsy (BMAB) is an essential tool for the diagnosis of hematological disorders. The most frequent complaint after BMAB is pain but the severity of this pain is described very different among patients. We investigated factors predicting this pain focusing on the role of state and trait anxiety. &#x0D; &#x0D; Methods: One hundred and ten adult patients undergoing BMAB, were informed adequately and assessed with “The State-Trait Anxiety Inventory” (STAI) before the procedure. In this Likert-type inventory, State Anxiety Scale evaluates the current state of anxiety, asking how respondents feel “at that moment”. The Trait Anxiety Scale evaluates relatively stable aspects of “anxiety proneness,” including general states of confidence, calmness, and security. After the biopsy, the pain was measured with visual analog scale.&#x0D; &#x0D; Results: Most of the patients (71.8%) described mild pain but moderate to severe pain were significantly more frequent in both high state and trait anxiety groups. Pain severity had a positive but weak correlation with trait anxiety but not with state anxiety. The described pain level was associated with older age but was not with an indication of biopsy, performance status, comorbidities or previous BMAB experiences.&#x0D; &#x0D; Conclusion: Results of our study made us thought that a good communication with the&#x0D; patient and talking about possible outcomes days before procedure might play a role in reducing&#x0D; his or her anxiety but because age and trait anxiety cannot be changed by using fast-acting&#x0D; anxiolytic drugs, the advantage of premedication with anxiolytics in order of reducing pain,&#x0D; would be limited.

Evaluation of bone marrow in patients with pancytopenia

Introduction : Pancytopenia is common hematological term described as decreased red blood cells, white cells and platelets in blood caused by either reduced production of haematopoietic cells in bone marrow or secondary destruction or reduction by drugs, toxins, radiotherapy, chemotherapy, infection etc. The diagnosis of causes for it are difficult to decide but few minimal invasive methods like bone marrow aspiration(BMA) and biopsy (BMB)are very useful. Objectives: To evaluate the diagnostic role of BMA and BMB in pancytopenia. Materials and Methods: This was observational study conducted over a period of 36 months on 145 patients. All age patients with new onset pancytopenia fulfilling inclusion criteria were included. Exclusion criteria: Radiation/chemotherapy induced pancytopenia. BMA and BMB were done in all cases. BMA smears were air dried and stained by Romanowsky stains while biopsy was fixed in formalin and sent for paraffin sectioning. BMA and BMB were analysed and data was statistically analysed. Results: Out of 145 patients, The mean age of the patients was 46years.Pallor and generalized weakness were commonest clinical complaints. Megaloblastic anemia was the most common cause (32%) followed by hypoplastic marrow in 16% cases. Rest causes were acute leukemia, anemia, myelodysplastic syndrome, metastases etc. Conclusion: BMA is good for studying morphology of hematopoietic cells while BMB for assessing cellularity and structure of bone marrow like fibrosis, infiltration & metastasis. BMA and BMB are complimentary with each other when used together for evaluation of bone marrow in routine haematological disorders. Keywords: Bone Marrow Aspiration, Bone Marrow Biopsy, Pancytopenia.

Procedural Pain and Serious Adverse Events with Bone Marrow Aspiration and Biopsy: Real World Experience from India

Background: Bone Marrow aspiration and Biopsy (BMAB) is perceived by patients as a painful procedure with fearsome complications. Though informed as safe and well tolerated; there is limited data about the complications and degree of pain experienced by patients undergoing BMAB.[1] Further scarce is data from the developing world where procedural fear discourages patients from pursuing treatment and diagnosis.[2] Methods Aims: To estimate the level of pain and frequency of serious adverse eventsexperienced by patients undergoing BMAB at our center. We also attempted to identify factors associated with increased pain perception. Study setting: This study was conducted at a tertiary level teaching hospital, the Christian Medical College &amp; Hospital, Ludhiana. Ethics approval was obtained from the Institutional research committee (CMC/1495). Study period: 01 April 2015 through 30 Nov 2019 Study Design: This is a comparative cross sectional study where comparison of those with relatively more pain to those with less was done to elicit the factors associated with pain perception. Study Population: All consecutive patients who underwent a BMAB and provided informed consent which was taken pre-procedure, were included. We excluded patients who underwent the procedure under general anesthesia. Logistics of the Study: The BMAB was performed variably by Consultant Physicians, Trainee Physicians and Physician Assistants. All patients were pre-medicated with tramadol intravenous pre-procedure, and the preferred approach was from the posterior superior iliac spine (PSIS) in a left lateral decubitus under local anesthesia with lignocain. Patients were sent home or returned to their ward after upto 60 minutes of observation. A serious adverse event was considered as one requiring a prolonged observation beyond routine practice or extending to an admission to manage adverse events following and related to the BMAB. Data sources and variables Information regarding age at diagnosis, address and sex, indication to perform the BMAB, coded as malignant and non-malignant was collected from each patient. Number of prior procedures and details regarding food intake were collected as recalled by the patient. Level of pain was noted soon after the BMAB using a combined Wong-Baker grimace with numeric pain scale by the patient themselves. Statistical Analysis: Descriptive statistics were used to characterize variables. Univariate and Multivariate Logistic Regression were used to identify factors associated with higher pain severity (Score &amp;gt;2). Results: A total of 942 BMAB procedures were performed in this period. Baseline characteristics as tabulated below (Table1). Although the Mean + SD pain score was only 2.7 + 1.39, fourteen patients (1.48%) reported severe pain (&amp;gt;8). The following risk-factors were associated with increased pain on multivariate analysis: those experiencing their first BMAB procedure had very low odds of pain (OR (95 % CI): 0.23 (0.15-0.37)). However, when more than one attempt of biopsy was made, the odds of pain was much higher (OR (95 % CI): 1.62 (1.29-2.05)). Food and drink intake prior to procedure was associated only at the univariate level. Those who did not take any food prior to procedure had very high odds of pain (odds ratio (OR) 1.81 (95 % CI 1.01-3.22)). However, those who took juice had very low odds (OR (95 % CI): 0.619 (0.43-0.90)). Nine (0.95%) serious adverse events were reported. There were no deaths. The major serious adverse event was hemorrhage resulting from pseudo-aneurysm of the posterior iliac artery, which comprised 2 of the 9 serious adverse events. Other serious adverse events included persistent vomiting and severe aching pain in the ipsilateral leg. Conclusions: In our analysis BMAB is associated with a low level of procedural pain and is safe. The pain perception was not influenced by the operator. Factors associated with decreased pain perception were first procedural BMAB experience and successful completion of the procedure in the first attempt. Having at least a snack or a juice pre-procedure could reduce pain perception. Serious adverse events are rare in our experience. Disclosures No relevant conflicts of interest to declare.

Utility of bone marrow aspirate and biopsy in staging of patients with T-cell lymphoma in the PET-Era – tissue remains the issue

The role of 18F-fluoro-2-deoxy-D-glucose positron emission tomography combined with computerized tomography (PET-CT) in evaluation of bone marrow involvement (BMI) in patients with T-cell lymphoma (TCL) is poorly understood. We investigated whether PET-CT could replace bone marrow aspiration and biopsy (BMAB) in TCL. Sixty patients with newly diagnosed TCL who underwent both diagnostic PET-CT and BMAB were identified. BMI was tissue-confirmed in 15 (25%) cases, however only 8 of these 15 showed BMI on PET-CT (sensitivity of 53.3%, specificity of 100%). BMI by BMAB was associated with lower progression-free survival (PFS) (p = 0.038) and overall survival (OS) (p = 0.003) while PET-CT BMI was associated only with OS (p = 0.02). BMI detected by BMAB in the setting of a negative PET-CT had similar inferior prognosis as BMI identified on PET-CT. Thus, PET-CT in TCL misses BMI in almost half of the cases detected by BMAB and hence cannot substitute BMAB in evaluation of TCL.

Efficacy and safety of bone marrow aspiration and biopsy using fluoroscopic guidance and a drill-powered needle: clinical experience from 775 cases.

To evaluate the efficacy and safety of performing a fluoroscopically guided bone marrow aspiration and biopsy (BMAB) using a drill-powered needle in a large patient population. This retrospective study received institutional review board approval with a waiver of patient informed consent. We identified all BMAB procedures from August 2012 through December 2016 performed at our institution using fluoroscopic guidance and a drill-powered needle. Clinical diagnosis, patient age, patient gender, biopsy site, biopsy needle gauge, bone marrow aspirate volume, bone marrow core biopsy length, patient platelet count, conscious sedation details, complications, and diagnostic adequacy were investigated for each case and summarized. A total of 775 BMAB procedures were performed and analyzed. These were performed in 436 female patients and 339 male patients ranging in age between 16 and 91 years (average age of 53 years). Samples obtained from the procedures in our series were diagnostic in 95.0% of cases. The complication rate for our series was 0.3%. The use of fluoroscopic guidance and a drill-powered needle for bone marrow aspiration and biopsy is a safe and efficacious procedure. • Fluoroscopy can be utilized for imaging guidance during bone marrow aspiration and biopsy. • The use of fluoroscopic guidance and a drill-powered needle for bone marrow aspiration and biopsy has a high diagnostic yield. • The procedure has an excellent patient safety profile.

Combined Oral Fentanyl Citrate and Midazolam as Premedication for Bone Marrow Aspiration and Biopsy in Patients with Hematological Malignancies: A Randomized, Controlled and Patient-Blinded Clinical Trial

Bone marrow aspiration and biopsy (BMAB) is a painful procedure, and the routinely used local infiltration anesthesia (LIA) with lidocaine is unable to provide pain relief during the most uncomfortable phases. The primary endpoint of the present randomized, patient-blinded trial was to evaluate the efficacy of an opioid and benzodiazepine combination plus LIA (sedoanalgesia) in patients undergoing BMAB for hematological malignancies. The secondary endpoint was the safety of the procedure in an outpatient setting. Ancillary assessments were anticipatory anxiety related to pain recall in the event of re-biopsy, and adequacy of bone tissue harvested. Patients were randomly assigned to one of 2 arms to receive either sedoanalgesic placebo plus LIA (standard group) or oral fentanyl citrate 200 μg plus oral midazolam 5 mg plus LIA (combo group) during BMAB. Pre-procedural anxiety and procedural pain were assessed according to the Numerical Rating Scale (NRS: 0–10), dividing the time of the procedure into five intervals (T0, T1, T2a, T2b and T3) and evaluating the degree of discomfort at each time (T) in both groups. One hundred and sixteen patients were eligible for the study. At T2b (time of biopsy) and T3 (time after biopsy), a significantly lower perception of pain was registered in the combo group. Moreover, there were no significant sedoanalgesia-related side-effects. Finally, histological specimens were higher in quality in the combo group. Sedoanalgesia was highly effective in reducing pain during biopsy, diminished anticipatory anxiety in patients undergoing re-biopsy and led to fewer non-diagnostic specimens being harvested.

PF733 COMBINED ORAL ANALGESIA AND ANXIOLYSIS FOR PAIN ASSOCIATED WITH BONE MARROW ASPIRATION AND BIOPSY

Background:Bone marrow aspiration and biopsy (BMAB) is a painful procedure, and the commonly adopted local infiltration anesthesia (LIA) with lidocaine is unable to relieve the pain during the most uncomfortable phases, or the anticipatory anxiety related to pain recalling thereafter. As there are no formal guidelines for adding a sedoanalgesic premedication before beginning the BMAB, many combinations have been adopted by several authors.Aims:Our randomized and patient blinded trial aimed to evaluate, as primary end point, the efficacy and safety of opioid and benzodiazepine agent combination plus LIA in patients who underwent BMAB for hematological malignancies. Two secondary end points were: 1) to define if patients who already underwent to BMAB without LIA prefer sedoanalgesia; 2) to demonstrate if sedoanalgesia can influence the quality of the biological specimen harvested.Methods:Patients were randomly assigned into two arms for receiving either placebo plus LIA (standard group, 48,6%) or oral fentanyl citrate 200 mcg + oral midazolam 5 mg in addition to LIA (combo‐group, 51,4%) during BMAB. Pre‐procedural anxiety and procedural pain were assessed according to the Numered Rating Scale (NRS: 0–10), dividing the time of the procedure into five intervals (T0, T1, T2a, T2b, and T3) and evaluating discomfort grade during each moment of procedure in both groups. Cognitive function was measured before and 30 minutes after the procedure. Possible side effects were recorded, as well as the adequacy of tissue samples harvested. A total number 116 patients were enrolled in the study. 9 patients did not meet inclusion criteria and were excluded. 52 patients were randomized and assigned to standard group and 55 to combo group.Results:At T2b and T3 (corresponding to the biopsy time and time after the biopsy, respectively) there was a significantly lower (p &lt; 0.05) perception of pain in the patients who received sedoanalgesia (combo‐group) compared to those who did not (standard group). Moreover, 100 % of the patients in combo group who had previously undergone this procedure without premedication reported that they would prefer sedoanalgesia for the subsequent procedures.Summary/Conclusion:Administration of oral analgesia and anxiolysis is a safe and feasible option to be used in outpatient setting; sedoanalgesia is very effective in reducing pain during the biopsy and it diminishes the anticipatory anxiety related to a painful procedure. Patients should have the possibility to choose between local anesthesia alone or sedoanalgesia plus local anesthesia.

Combined oral administration of analgesia and anxiolysis for pain associated with bone marrow aspiration and biopsy.

e18313 Background: Bone marrow aspiration and biopsy (BMAB) is a painful procedure, and the commonly adopted local infiltration anesthesia (LIA) with lidocaine is unable to relieve the pain during the most uncomfortable phases, or the anticipatory anxiety related to pain recalling thereafter. As there are no formal guidelines for adding a sedoanalgesic premedication before beginning the BMAB, many combinations have been adopted by several authors. Our randomized and patient blinded trial aimed to evaluate, as primary end point, the efficacy and safety of opioid and benzodiazepine agent combination plus LIA in patients who underwent BMAB for hematological malignancies. Two secondary end points were: 1) to define if patients who already underwent to BMAB without LIA prefer sedoanalgesia; 2) to demonstrate if sedoanalgesia can influence the quality of the biological specimen harvested. Methods: Patients were randomly assigned into two arms for receiving either placebo plus LIA (standard group, 48,6%) or oral fentanyl citrate 200 mcg + oral midazolam 5 mg in addition to LIA (combo-group, 51,4%) during BMAB. Pre-procedural anxiety and procedural pain were assessed according to the Numered Rating Scale (NRS: 0-10), dividing the time of the procedure into five intervals (T0, T1, T2a, T2b, and T3) and evaluating discomfort grade during each moment of procedure in both groups. Cognitive function was measured before and 30 minutes after the procedure. Possible side effects were recorded, as well as the adequacy of tissue samples harvested. A total number 116 patients were enrolled in the study. 9 patients did not meet inclusion criteria and were excluded. 52 patients were randomized and assigned to standard group and 55 to combo group. Results: At T2b and T3 (corresponding to the biopsy time and time after the biopsy, respectively) there was a significantly lower ( p&lt; 0.05) perception of pain in the patients who received sedoanalgesia (combo-group) compared to those who did not (standard group). Moreover, 100 % of the patients in combo group who had previously undergone this procedure without premedication reported that they would prefer sedoanalgesia for the subsequent procedures. Conclusions: Administration of oral analgesia and anxiolysis is a safe and feasible option to be used in outpatient setting; sedoanalgesia is very effective in reducing pain during the biopsy and it diminishes the anticipatory anxiety related to a painful procedure. Patients should have the possibility to choose between local anesthesia alone or sedoanalgesia plus local anesthesia.

Bone marrow examination in patients with Ewing sarcoma/peripheral primitive neuroectodermal tumor without metastasis based on 18F-fluorodeoxyglucose positron emission tomography/computed tomography

Ewing sarcoma/peripheral primitive neuroectodermal tumor (ES/PNET) is an aggressive bone tumor. Bone marrow aspiration and biopsy (BMAB) has been recognized as the gold standard for assessing bone marrow status. While the latest guideline suggests the need to omit bone marrow aspiration in patients with no findings on 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) based on one retrospective report, there is no study using 18F-FDG PET/computed tomography (CT). We retrospectively reviewed 26 consecutive, previously untreated, ES/PNET patients. We compare the results of bone marrow aspiration and biopsy (BMAB) and those of 18F-FDG PET/CT in ES/PNET patients. All of the 21 patients without metastases on 18F-FDG PET/CT had negative BMAB. The sensitivity of bone marrow involvement in bone metastases positive patients on 18F-FDG PET/CT was 75% (3/4), and the specificity was 100% (22/22). In addition to the metastatic findings on 18F-FDG PET/CT, tumor diameter, lactate dehydrogenase level at diagnosis, and the presence or absence of bone metastasis were factors related to bone marrow involvement. It may be a reasonable option to omit BMAB in ES/PNET patients with no distant metastasis based on 18F-FDG PET/CT findings.

Sacroiliac joint pain following iliac-bone marrow aspiration and biopsy: a cohort study.

Background: Sacroiliac joint (SIJ) pain is a common source of lower back pain; the factors associated have not been studied in cancer patients. Observing patients with bone marrow aspiration and biopsy (BMAB) who subsequently developed SIJ-pain led to this investigation. Aim: To investigate this possible relationship. Methods: A cohort study of cancer patients diagnosed with SIJ pain. The association of BMAB with SIJ pain was evaluated, as were variables that differed between the groups. Results: The prevalence of SIJ pain was 4.95% (231/4669). Among 231 patients with SIJ pain, 34% (78/231) did not have prior history of lower back pain and had undergone BMAB prior to their diagnosis of SIJ pain. A statistically significant association between BMAB-SIJ-pain was found (p <0.01). Conclusion: We found linear correlation between BMAB and subsequent SIJ pain.

A Multivariate Analysis of Pain and Distress in Adults Undergoing BMAB.

Clinicians routinely perform bone marrow aspiration and biopsy (BMAB) to diagnose cancer and evaluate disease status; however, few studies address pain and distress with BMAB. A prospective descriptive-correlational design examined patients' (N = 152) ratings of pain intensity (numeric rating scale, 0-10) and distress (distress thermometer) at baseline and 5 min and 1 hr postprocedure. Data were analyzed using descriptive statistics, chi-square, and linear regression models. Mean postprocedure pain intensity at 5 min was moderate, 5.56 (SD = 3.03), and opioid use was associated with decreased pain at 1 hr (p < .001). Preprocedure administration of anxiolytics had no significant effect on distress reduction (p = .88). Being female, first-time biopsy, and increased preprocedure pain were significant predictors of postprocedure distress (p < .001). Treating anxiety alone may not be sufficient to lessen pain and distress. Individualized plans of care should be based on patient risk and response to procedure.