ADEQUACY OF BONE-MARROW TREPHINE BIOPSY SPECIMENS IN CHILDREN

Aims-To evaluate success in obtaining adequate bone marrow trephine bi opsy cores from children. Methods-Sections of trephine biopsy cores su bmitted by 25 centres from children with neuroblastoma over a five yea r period were reviewed centrally. In cores containing no tumour adequa cy was defined as 0.5 cm of well preserved bone marrow after processin g. Occasional smaller cores containing obvious tumour were also consid ered adequate. Results-Of 822 biopsy specimens, 139 (17%) were inadequ ate. In 13 centres submitting at least 20 cores failure rates ranged f rom 2 6 to 50%. There was no improvement over the five years of the st udy. There was no practically important correlation between the number s of cores submitted and success in obtaining adequate specimens. Alth ough a lower rate of inadequate biopsy specimens was found when haemat ologists rather than diatricians (13 v 29%) were the dominant operator s this should not be overinterpreted, not least because of the potenti ally confounding association between haematologist operators and large r numbers of biopsy specimens, and because the arbitrary subdivision o f centres according to operator specialty was crude. The skill of indi vidual operators could not be assessed. Conclusions-Many operators do not obtain adequate bone marrow biopsy specimens from children. Improv ement is necessary because this is an invasive investigation, often pe rformed under general anaesthesia. Reporting pathologists are well pla ced to influence practice by pointing out inadequacies in the specimen and suggesting retraining or even a change in operator. Improvement w ould almost certainly occur if this investigation was restricted to lo cally recognised successful operators, whatever their specialty. Most centres should review their practice and devise strategies to improve their ability to obtain adequate cores.