Download PDF
CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2020; 4(01): 16-19
DOI: 10.1055/s-0039-3401330
Original Article

Safety and Technical Success of CT-Guided Bone Marrow Biopsy in Obese Patients

Barbara Manchec
1   Department of Radiology, Advent Health, Orlando, Florida, United States
,
Joseph Limback
1   Department of Radiology, Advent Health, Orlando, Florida, United States
,
Bo Liu
2   Miami Cardiac and Vascular Institute, Miami, Florida, United States
,
Julie W Pepe
3   Center for Collaborative Research, Advent Health, Orlando, Florida, United States
,
Jeremy Burt
1   Department of Radiology, Advent Health, Orlando, Florida, United States
,
Francisco Contreras
1   Department of Radiology, Advent Health, Orlando, Florida, United States
,
Thomas J. Ward 
1   Department of Radiology, Advent Health, Orlando, Florida, United States
› Author Affiliations Financial Disclosures None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Purpose Obesity can make bone marrow biopsy using manual landmarks as guidance technically challenging. This retrospective review was performed to assess the safety and technical success of performing bone marrow biopsies with computed tomography (CT)–guidance in obese patients.

Materials and Methods This single-institution, retrospective study included 1,016 CT-guided bone marrow biopsies performed between 2009 and 2016. Thirty-four percent (n = 348) were performed in patients with a body mass index (BMI) of 30 kg/m2 or greater, and 7% (n = 75) were performed in patients with a BMI greater than 40 kg/m2. Demographic information, BMI, and complications were reviewed. The primary endpoint was technical success and procedurally related hemorrhagic complication. The electronic medical record was reviewed to identify procedural related hemorrhagic complications, Common Terminology Criteria for Adverse Events (CTCAE) Grade 3 or above. The complication rates in obese patients were compared with patients with a BMI less than 30 kg/m2.

Results Biopsy was successfully performed in all patients. No biopsies resulted in a CTCAE Grade 3 or above complication. There was no difference in complication rate (0%) based on BMI. For patients with a BMI < 30 kg/m2, BMI ≥ 30 kg/m2, and BMI > 40 kg/m2, complications rates were 0% (95% confidence interval [CI]: 0–0.4%), 0% (95% CI: 0–0.9%), and 0% (95% CI: 0–4%), respectively.

Conclusions CT-guided bone marrow biopsy in obese patients can be performed with a high rate of technical success and is safe. If patient body habitus limits the ability to palpate physical landmarks needed to perform bone marrow biopsy without image guidance, CT-guided bone marrow biopsy should be considered.

Keywords

bone marrow examination - image-guided biopsy - obesity


Publication History

Article published online:
29 April 2020

© .

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Hyun BH, Stevenson AJ, Hanau CA. Fundamentals of bone marrow examination. Hematol Oncol Clin North Am 1994; 8 (04) 651-663
    CrossrefPubMedGoogle Scholar
  • 2 Riley RS, Williams D, Ross M. et al. Bone marrow aspirate and biopsy: a pathologist’s perspective. II. interpretation of the bone marrow aspirate and biopsy. J Clin Lab Anal 2009; 23 (05) 259-307
    CrossrefPubMedGoogle Scholar
  • 3 Bain BJ. Bone marrow biopsy morbidity: review of 200. J Clin Pathol 2005; 58 (04) 406-408
    CrossrefPubMedGoogle Scholar
  • 4 Bain BJ. Bone marrow biopsy morbidity and mortality: 2002 data. Clin Lab Haematol 2004; 26 (05) 315-318
    CrossrefPubMedGoogle Scholar
  • 5 Bain BJ. Morbidity associated with bone marrow aspiration and trephine biopsy—a review of UK data for 2004. Haematologica 2006; 91 (09) 1293-1294
    PubMedGoogle Scholar
  • 6 Bain BJ. Bone marrow biopsy morbidity and mortality. Br J Haematol 2003; 121 (06) 949-951
    CrossrefPubMedGoogle Scholar
  • 7 Braekkan SK, van der Graaf Y, Visseren FL, Algra A. Obesity and risk of bleeding: the SMART study. J Thromb Haemost 2016; 14 (01) 65-72
    CrossrefPubMedGoogle Scholar
  • 8 Delhaye C, Wakabayashi K, Maluenda G. et al. Body mass index and bleeding complications after percutaneous coronary intervention: does bivalirudin make a difference?. Am Heart J 2010; 159 (06) 1139-1146
    CrossrefPubMedGoogle Scholar
  • 9 Devaliaf V, Tudor G. Bone marrow examination in obese patients. Br J Haematol 2004; 125 (04) 538-539
    CrossrefPubMedGoogle Scholar
  • 10 Friedlis MF, Centeno CJ. Performing a better bone marrow aspiration. Phys Med Rehabil Clin N Am 2016; 27 (04) 919-939
    CrossrefPubMedGoogle Scholar
  • 11 Konda B, Pathak S, Edwin I. et al. Safe and successful bone marrow biopsy: an anatomical and CT-based cadaver study. Am J Hematol 2014; 89 (10) 943-946
    CrossrefPubMedGoogle Scholar
  • 12 Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith AD. American Association for the Study of Liver Diseases. Liver biopsy. Hepatology 2009; 49 (03) 1017-1044
    CrossrefPubMedGoogle Scholar
  • 13 Mukhtar KN, Mahmood SN, Umair SF. CT guided percutaneous renal biopsy versus ultrasound guided for obtaining adequate tissue. J Pak Med Assoc 2012; 62 (09) 880-882
    PubMedGoogle Scholar
  • 14 U. S. Department of Health and Human Services, National Institute of Mental Health, National Cancer Institute. Common Terminology Criteria for Adverse Events (NIH Publication No. 09–5410). Bethesda, MD: U.S. Government Printing Office; 2015
    Google Scholar
  • 15 Liu B, Limback J, Kendall M. et al. Safety of CT-guided bone marrow biopsy in thrombocytopenic patients: a retrospective review. J Vasc Interv Radiol 2017; 28 (12) 1727-1731
    CrossrefPubMedGoogle Scholar
  • 16 Riley RS, Hogan TF, Pavot DR. et al. A pathologist’s perspective on bone marrow aspiration and biopsy: I. Performing a bone marrow examination. J Clin Lab Anal 2004; 18 (02) 70-90
    CrossrefPubMedGoogle Scholar
  • 17 Badiola CM, Scappaticci F, Brahaj D. CT guided bone marrow aspiration and core biopsy. Open Journal of Radiology 2012; 2 (02) 55-56
    CrossrefPubMedGoogle Scholar
  • 18 Hernigou P, Desroches A, Queinnec S. et al. Morbidity of graft harvesting versus bone marrow aspiration in cell regenerative therapy. Int Orthop 2014; 38 (09) 1855-1860
    CrossrefPubMedGoogle Scholar
  • 19 Ghosh K. Bone marrow examination in obese patients: CAT or not to CAT!. Br J Haematol 2004; 127 (02) 230-231, authorreply 231
    PubMedGoogle Scholar
  • 20 World Health Organization. Obesity and overweight fact sheet. Available at: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed March 13, 2020
    PubMed
  • 21 Griselli F, Calvagna C, Sgorlon G. et al. Management of an iatrogenic pseudoaneurysm of the superior gluteal artery by percutaneous ultrasound-guided thrombin injection: a case report. Ann Vasc Surg 2017; 38: 317.e9-317.e11
    CrossrefPubMedGoogle Scholar
  • 22 Arellano-Rodrigo E, Real MI, Muntañola A. et al. Successful treatment by selective arterial embolization of severe retroperitoneal hemorrhage secondary to bone marrow biopsy in post-polycythemic myelofibrosis. Ann Hematol 2004; 83 (01) 67-70
    CrossrefPubMedGoogle Scholar
  • 23 Yap WT, Jeffrey RB. Sonographic diagnosis of a superior gluteal artery arteriovenous fistula and pseudoaneurysm after bone marrow biopsy. J Ultrasound Med 2016; 35 (05) 1104-1106
    CrossrefPubMedGoogle Scholar
  • 24 Caldwell IR, Buckley BT, Rajagopal R, Doocey R, Pemberton L. Traumatic superior gluteal artery pseudoaneurysm following a bone marrow biopsy. Intern Med J 2016; 46 (03) 374-375
    CrossrefPubMedGoogle Scholar
  • 25 Ge PS, Ng G, Ishaque BM, Gelabert H, de Virgilio C. Iatrogenic pseudoaneurysm of the superior gluteal artery presenting as pelvic mass with foot drop and sciatica: case report and review of literature. Vasc Endovascular Surg 2010; 44 (01) 64-68
    CrossrefPubMedGoogle Scholar
  • 26 Al Zahrani Y, Peck D. Median sacral artery injury following a bone marrow biopsy successfully treated with selective trans-arterial embolization: a case report. J Med Case Reports 2016; 10: 42
    CrossrefPubMedGoogle Scholar