The Solid Core (Trephine) Bone Marrow Biopsy Needle; Advantages of Employing A Biopsy Needle with Core Retention Design
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2019, Vol 18, Issue 4
Abstract
The technique of bone marrow trephine (solid core) biopsy was first introduced by Ghedini of Genoa in 1908 when he performed a surgical bone marrow biopsy on a patient to aid in the diagnosis of a hematologic disease. He obtained a sample of bone and marrow from the upper end of the tibia of an adult using a manual trephine [1]. The value of bone marrow trephine biopsy in the investigation and diagnosis of bone and bone marrow disorders has long been recognized [2-4] and has gained acceptance among hematologists and oncologists. This is specifically due to two reasons; (a) the development of new needles [5,6] ensuring that the biopsies can be carried out with minimal discomfort for the patient while imposing little or no damage to the biopsied tissue, and (B) improvements in the technique of processing bone marrow biopsies in plastic (methyl and glycol-methacrylate) which require no decalcification [7]. This approach provides thin (1-2 μm) sections of high histological quality that are stainable with Romanowsky type stains (Giemsa or May-Grunwald & Giemsa) providing excellent cytomorphologic detail of the haemopoietic tissue (Figures 1 & 2). It has also become apparent that in some cases additional diagnostic and prognostic information can be obtained from an adequately processed and properly stained bone marrow biopsy sections than from a dry film smears alone [8,9]. In general, both procedures are considered essential and complimentary [8]. An optimal clinical evaluation of the bone marrow requires an examination of air dried and well stained smears of the aspirated tissue along with a histopathological evaluation of adequately processed and properly stained core biopsy specimens. Currently several bone marrow biopsy needles are available. Unfortunately, not all of them provide good quality biopsy specimens for histological evaluation or are user friendly.The earlier trephine instruments such as Bordier’s [10], Nottar Labhard’s [11], Burkhardt’s [7] and Gidlund’s instruments [12] were large and bulky, contained multiple components, were cumbersome to use, and required an open surgical procedure. Above all they could not be repeated at the same site for at least 4-6 months. In the 1970s the Jamshidi bone marrow biopsy needle [13,14] presented a significant improvement in the technique of bone marrow biopsy procedure. This needle appeared to offer the best compromise between the larger Bordier’s, Notter-Labhardt’s, Burkhardt’s and Gidlund’s instruments and the other less satisfactory Sacker Nordin bone marrow biopsy needle [15]. However, a major drawback of the Jamshidi needle was that the biopsy specimens frequently slipped out of the needle during its withdrawal due to lack of a core retention device (Figure 3) and remained within the patient. This required a second or third attempt and further discomfort for the patient. Furthermore, the Jamshidi needle technique also required rocking or sculling movement or a change in the direction of the tip of the needle to secure the biopsy specimen. As a result, the needles were often bent and damaged.
Authors and Affiliations
Anwarul Islam
Keywords
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- EP ID EP622594
- DOI 10.26717/BJSTR.2019.18.003192
- Views 145
- Downloads 0
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