Jamshidi Needle Research Articles

The value of needle biopsy in the diagnosis of musculoskeletal tumors

Percutaneous needle biopsy has many advantages over open biopsy in the treatment of neoplasms. However, the accuracy of the needle biopsy in the diagnosis of musculoskeletal tumors has not been established. It is essential to evaluate the accuracy and limitations of the procedure in musculoskeletal tumors. The diagnoses from 66 needle biopsies (bone, 37; soft tissue, 29) performed on 64 consecutive patients using a jamshidi needle (bone tumors) or a Tru-cut needle (soft tissue tumors) were compared with the final diagnoses made by open biopsy and/or a definitive operation. Fifty-eight specimens (87.9%) were judged to be adequate for histological examination. It was technically difficult to obtain undamaged cores from very hard bony lesions or sclerotic cyst walls. A pathologist with experience in musculoskeletal tumors was able to differentiate malignant tumors from benign lesions in 98.3% of the cases (bone, 100%; soft tissue, 96.4%) and arrive at a specific diagnosis in 91.4% (bone, 100%; soft tissue, 82.1%) when adequate cores were obtained. It was troublesome to distinguish a well-differentiated liposarcoma from a benign lipoma, or inflammatory lesions from benign tumorous conditions. The overall accuracy for needle biopsy was 80.3% (bone, 81.1%; soft tissue, 79.3%). There was no morbidity related to the procedure. The results indicate that meedle biopsy is a safe and accurate technique for diagnosing musculoskeletal tumors.

Audit of bone marrow trephines.

To establish criteria of adequacy for bone marrow trephine biopsy specimens and to audit the quality of trephines performed at the Christie Hospital, Manchester. Trephines (n = 767) performed over 12 months were reviewed. Their lengths, and the lengths of their constituent parts (soft tissue, cortex, crushed marrow and interpretable marrow) were measured. The mean performance of each operator was calculated. Criteria of adequacy were established by a review of the published findings and an analysis of the relation between trephine length and the rate of infiltration by tumour. Before processing, the average trephine was 1.59 cm long. Trephines shrunk by 25% during processing. In histological sections the average length was 1.15 cm, consisting of 0.09 cm of soft tissue, 0.04 cm of cortex, 0.26 cm of disrupted marrow and 0.74 cm of interpretable marrow. A large number of operators were taking trephine biopsy specimens and their performance varied considerably. Review of the published findings suggested that the minimum adequate length is in the range 1.5 cm to 2.0 cm. The analysis of the relation between length of trephine and the rate of positivity for neoplasia yielded a minimum adequate length of 1.2 cm in section (1.6 cm before processing). Fifty eight per cent of the trephines were inadequate by this criterion. There was a tendency for the Jamshidi needle to produce a longer trephine than the Islam needle. According to objective criteria, at the Christie Hospital, many operators are producing a high proportion of inadequate bone marrow trephines.

Adaptor for Jamshidi needles to enhance penetration of hard bone [letter

Adaptor for Jamshidi needles to enhance penetration of hard bone [letter

The Cytological Recognition of African Siderosis On Bone Smears

Eight cases of African siderosis primarily recognized on cytological smears are presented and discussed. All the smears were obtained from Jamshidi needle biopsies of vertebral bodies. Six cases showed siderosis only, while a seventh showed two pathological processes on one slide, namely metastatic keratinizing squamous carcinoma and siderosis. The remaining case showed cytological evidence of tuberculosis and siderosis. All cases were histologically confirmed, an additional feature in two cases being osseous tuberculosis which was not evident on the cytological smears. A search of the literature failed to reveal any report on the cytological recognition of this disease, or its association with tuberculosis.

Histology and immunohistology of bone marrow biopsy in multiple myeloma.

B5-fixed/paraffin-embedded Jamshidi needle biopsies from 125 multiple myeloma patients were reviewed according to both morphological and immunohistological criteria. At microscopic examination, the following parameters were evaluated: i) grade of malignancy (low = 56; intermediate = 50; high = 19); ii) growth pattern (interstitial +/- sheets/nodules = 90; nodular = 13; packed marrow = 18; sarcomatous = 4); III) histological stage (I = 64; II = 35; III = 26). Comparison of the findings in trephine biopsies and aspirates showed that in 30% of the cases the latter led to an underestimation of the tumor burden. Immunohistochemical determination of Ig easily allowed: i) differential diagnosis from exuberant reactive plasmacytosis; ii) recognition and counting of neoplastic plasma cells; iii) detection of minimal residual disease after treatment. Immunohistochemistry also confirmed phenotypic aberration of neoplastic plasma cells, showing positivity for CD45, EMA, and cytokeratins in 14%, 59%, and 25% of the cases, respectively. Furthermore, it displayed expression of the P-glycoprotein in 4/8 resistant cases. These findings underline that routinely processed Jamshidi needle biopsies can be of great value in the study of patients with multiple myeloma.

Utility of Buffy Coat Preparation in Bone Marrow Interpretation: Improving Diagnostic Output in Clotted, Diluted, and Scanty Aspirates

Different bone marrow aspirate preparations, including push films, particle sections, imprint films of the core biopsy specimen, and buffy coat preparation (BCP), were compared with the bone marrow biopsy specimen to assess the usefulness of BCP. BCP from 29 scanty, diluted, or clotted bone marrow aspirates of a total of 489 aspirates performed over a 15-month period were analyzed. The 29 BCPs were obtained from patients with anemia (seven cases), leukemia (six cases), nonhematopoietic malignancies (six cases), lymphomas (five cases), and other hematologic diseases (five cases). BCP provided diagnostic information in 25 of 29 cases–a considerably improved yield compared with particle sections (4/26), imprint smears of a Jamshidi needle biopsy (7/21), and push smears of the aspirate (3/15). Assessment of iron stores was possible in 9 of 29 cases. We conclude that BCP is a simple technique that increases the diagnostic output in cases of scanty, diluted, or clotted marrow aspirates when a bone marrow biopsy specimen is not available.

Essential mixed cryoglobulinemia, type II: a manifestation of a low-grade malignant lymphoma? Clinical-morphological study of 12 cases with special reference to immunohistochemical findings in liver frozen sections.

Twelve patients with clinical and laboratory findings typical of essential mixed cryoglobulinemia, type II (EMC II) underwent multiple liver and bone marrow biopsies. In 9 of 12 cases (all hepatitis B surface antibody-negative), routine histology revealed patent infiltration of liver portal tracts, lobules and sinusoids by small lymphocytes provided with cytological characteristics closely resembling those of the LP immunocytoma of the Kiel classification. At immunophenotyping on frozen sections, these elements expressed the CD22 antigen (marker of B cells) and bore the same type of immunoglobulin (IgM/k = 8, IgM/lambda = 1) as the monotypic component in the serum. Furthermore, in 7 of 9 patients repeated bone marrow needle biopsies showed multiple foci of infiltration by plasmacytoid cells, often with paratrabecular location. In the remaining 3 cases (all hepatitis B surface and core antigen-positive), liver biopsies were consistent with a diagnosis of cirrhosis (two) or chronic active hepatitis (one). In two of them, however, Jamshidi needle biopsy evidenced bone marrow infiltrates quite similar to those observed in the other group. On the basis of these findings, the authors discuss the hypothesis that most EMC II are substained by a low-grade malignant lymphoma.

Bone marrow evaluation in small cell carcinoma of the lung.

Bone marrow examination is commonly included in the staging of small cell lung carcinoma (SCLC). We reviewed marrow samples of 103 patients. Marrow examination was mainly performed by unilateral or bilateral biopsy of iliac crests, using a Jamshidi needle. Only 6 of 97 evaluable cases (6.2 per cent) were positive for marrow metastases at staging, and in 3 cases (3 per cent) bone marrow was the only metastatic site. No focal metastases were found in additional sections made from the blocks of negative samples. In our experience bone marrow biopsy was of little value in staging SCLC. Bilateral biopsy plus aspirate, with the addition of more sophisticated staining techniques might, however, provide a higher yield of positive marrow involvement.

Sampling error in diagnosing hyperparathyroid changes in bone in small needle biopsies.

Sampling error in diagnosing the effects of hyperparathyroidism on bone was studied retrospectively by subdividing large-core bone biopsy samples and evaluating them histologically. We used intratrabecular osteoclastic tunneling resorption as the diagnostic feature of secondary hyperparathyroidism in 10 hemodialysis patients. All biopsies were taken with a large-core bone biopsy instrument, resulting in a mean biopsy width of 5 mm. The processed tissue slides were divided into halves (mean width 2.5 mm) and subsequently into thirds (mean width 1.6 mm), mimicking smaller bone biopsy instruments such as the Jamshidi needle. In 30% of the cases the diagnosis of secondary hyperparathyroidism would have been missed if taken by a Jamshidi-type needle, and 60% if taken by a needle with a core diameter of 1.6 mm. Our findings emphasize the necessity of utilizing large-core bone biopsies in diagnosing certain metabolic bone diseases.

Severe Bleeding Complicating Percutaneous Bone Marrow Biopsy

To the Editor .—A 78-year-old man was admitted for the evaluation of anorexia and weight loss of three weeks' duration. Physical examination showed a pale patient with slight dyspnea, regular pulse rate of 92 beats per minute, and blood pressure of 170/100 mm Hg. Crepitant rales were heard over both lungs, and the liver was palpated 2 cm below the costal margin. Rectal examination revealed an enlarged prostate. Laboratory studies disclosed the following values: hemoglobin, 11 g/dL with macrocytic indexes; ESR, 90 mm/hr (Westergren); serum alkaline phosphatase, 168 IU/L; calcium, 2.4 mmole/L; and phosphorus, 1.04 mmole/L. The total acid phosphatase level was elevated (16 IU), while the prostatic portion was normal. Protein was undetectable in the A bone marrow aspirate yielded "dry tap." Therefore, a bone mar[ill] biopsy was performed from the p[ill]terosuperior iliac spine. While [ill] Jamshidi needle 1 was introduced, friable bony tissue was felt. As [ill] guide of the

Bone scan appearances following biopsy of bone and bone marrow.

The influence of sternal marrow aspiration, iliac crest marrow aspiration, and iliac crest bone biopsy on bone scan appearances was examined. Eighteen patients were scanned a mean of 9.9 days after sternal marrow aspiration with a Salah needle (diameter 1.2 mm). Only one patient had an abnormality at the biopsy site. Bone scans obtained in 9 patients a mean of 10 days after iliac crest trephine marrow biopsy with a Jamshidi needle (diameter 3.5 mm) showed no abnormality at the biopsy site. In 18 patients with metabolic bone disease who had undergone iliac crest bone biopsy with an 8-mm needle, a scan abnormality due to the biopsy was usually present when the interval between the biopsy and the scan was 5 days to 2 months. Patients who were scanned within 3 days of iliac crest bone biopsy or more than 2 months after biopsy had normal scan appearance at the biopsy site.

Bone marrow examination in small cell carcinoma of the lung. Comparison of trephine biopsy with aspiration

Bone marrow examinations in 146 patients with small cell carcinoma of the lung were reviewed. The results of trephine biopsy and aspiration were compared in 128 patients in whom both techniques were performed. Twenty-seven of the 128 examinations (21.2%) showed positive aspirates and 30 biopsies (23.4%) revealed metastatic disease. The overall agreement between the aspirates and biopsies was 96.1%. Thirty-one patients (24.2%) had metastatic tumor in either aspirate or biopsy: 4 of these (12.9%) had a positive biopsy with negative aspirate, and 1 (3.2%) showed a positive aspirate and negative biopsy. The Jamshidi needle was used, yielding an average of 4.1 cm of core material per biopsy. The authors conclude that bone marrow biopsy using the Jamshidi needle is equivalent to aspiration. Although both procedures are complementary, a satisfactory specimen obtained with the Jamshidi needle alone may yield nearly equal detection to the combined procedures. Some guidelines for obtaining an optimal biopsy specimen are suggested.

Osteoid in bones of elderly patients without bone disease.

Bone samples were taken at post-mortem examination by Jamshidi needles from 88 elderly patients who were known to have normal bone biochemistry in life. The extent of osteoid in these samples is quantitatively described. In patients with normal creatinines the relative osteoid area ranges from 0 to 3.7% and trabecular osteoid surface percentage ranges from 0 to 23%, but higher values were seen in those with raised creatinines. Osteoid extent did not vary with age, sex or time of year. Descriptions of other series of control bone biopsies in the literature are reviewed and it is suggested that relative osteoid area greater than 3.5% or osteoid surfaces greater than 25% should be considered excess osteoid.

Comparison of different bone-biopsy techniques for qualitative and quantitative diagnosis of metabolic bone diseases.

In this study we evaluated different biopsy techniques for the quantitative study of bone histology. Bone biopsies were done using an electric drill and a Jamshidi needle after tetracycline double-labeling in patients with renal bone disease, osteoporosis, or Paget's disease. Bone slides were stained with Masson-Goldner stain and evaluated for quantitative static and dynamic parameters of bone structure, formation, and resorption. Statistical evaluation of the differences and correlations between histomorphometric parameters obtained from slides of bone samples thirty-five millimeters long and five or three millimeters in diameter revealed that three-millimeter samples were sufficient for qualitative diagnosis but were not optimum for the quantitative evaluation of cellular parameters of resorption and dynamic parameters of formation. A useful compromise might be the use of a four-millimeter specimen obtained with the less invasive technique that hitherto has been employed only for smaller samples. Several bone-biopsy techniques are available that provide bone samples of different sizes. Knowledge of the smallest sample size that is sufficient for qualitative and quantitative diagnosis of metabolic bone diseases will help the physician to select the least-invasive techniques without losing relevant information.

SCREENING FOR SUBCLINICAL OSTEOMALACIA IN THE ELDERLY: NORMAL RANGES OR PRAGMATISM?

Although osteomalacia is known to be common in some sections of the elderly population, the disease is often subclinical and there is uncertainty about the point at which treatment is necessary. Identification and treatment of osteomalacia are inseparably bound; the response of varying degrees of subclinical disease to treatment with vitamin D or alfacalcidol is described here. The response is assessed in relation to a simply derived reference range based on standard biochemical measurements together with a Jamshidi needle biopsy of the iliac crest. Although this technique does not define a truly normal range it identifies a treatable abnormality which could form the basis of further study of the problem of subclinical osteomalacia in the elderly.

Clinical relevance of bone marrow biopsy in staging and follow-up of breast cancer.

Bone marrow biopsies by Jamshidi needle were performed in 106 breast cancer female patients. Sixty-four of them were in follow-up after mastectomy, and neoplastic involvement of marrow was found in 21 patients (32.8%). Among the 42 women undergoing staging before mastectomy, the incidence of marrow involvement was 11.9% (5 women, all with radiographic positivity). Of the 37 women, either in follow-up or in the staging phase, with bone metastases detected by roentgenographic and isotopic examination, the bone biopsy was positive in 23 (62.1%), and 7 histologically had micrometastases. Three women, without any radiographic or isotopic sign of metastases, had positive biopsies. A good correlation was found between the hydroxyproline:creatinine ratio and neoplastic involvement of bone marrow.

Diagnostic bone-marrow studies extended routinely by iliac crest biopsy, using the method of Schaadt-Fischer.

The value of routinely including biopsy of the iliac crest in the haematological diagnostic programme in medical departments of haematology is elucidated by analysis of 129 biopsies. At the same time, imprints of the biopsies and aspirate smears were compared as regards diagnostic efficacy, which proved 15% greater for imprints and biopsies. The frequency of an inadequate bone biopsy was 7.7%, often because the biopsies were less than 5 mm in length (16%). The individual categories, bone biopsy, imprint, and aspiration smears were of equal diagnostic efficacy in 76%. Guidance for the haematological diagnosis was obtained in 80% of the cases. The incidence of dry tap was 1.6% and the complication rate 1.6%. The optimal result, viz. sufficiently long biopsies (54% over 10 mm in length), is obtained by taking the biopsy with a conically tipped needle (the Jamshidi or Schaadt-Fischer needle) and by making imprints before embedding the biopsies in methacrylate JB IV. The preparation and safety measures in embedding in JB IV and subsequent special staining, including cytochemical studies, are described. By the technique used, it is possible, with some practice, to obtain adequate biopsies in 80-90% of all patients and to take a biopsy and perform aspiration in one session. The patient's position, lying on his side, seems to make him less apprehensive.

Jamshidi骨髄生検針によるイヌの骨髄穿刺について

Jamshidi骨髄生検針によるイヌの骨髄穿刺について

Jamshidi needle biopsy of bone lesions

The technique and advantages of using a Jamshidi needle for skeletal biopsies are described, together with the results of 50 consecutive biopsies. A combined clinical, radiological and pathological approach to the lesions can provide the diagnosis in the majority of patients.

Jamshidi骨髄生検針による牛の骨髄穿刺法ならびにワラビ中毒症への応用

Jamshidi骨髄生検針による牛の骨髄穿刺法ならびにワラビ中毒症への応用