Reid M M, Roald B
Department of Haematology, Royal Victoria Infirmary, Newcastle upon Tyne.
J Clin Pathol. 1996 Mar;49(3):226-9. doi: 10.1136/jcp.49.3.226.
To evaluate success in obtaining adequate bone marrow trephine biopsy cores from children.
Sections of trephine biopsy cores submitted by 25 centres from children with neuroblastoma over a five year period were reviewed centrally. In cores containing no tumour adequacy was defined as 0.5 cm of well preserved bone marrow after processing. Occasional smaller cores containing obvious tumour were also considered adequate.
Of 822 biopsy specimens, 139 (17%) were inadequate. In 13 centres submitting at least 20 cores failure rates ranged from 2.6 to 50%. There was no improvement over the five years of the study. There was no practically important correlation between the numbers of cores submitted and success in obtaining adequate specimens. Although a lower rate of inadequate biopsy specimens was found when haematologists rather than paediatricians (13 v 29%) were the predominant operators this should not be overinterpreted, not least because of the potentially confounding association between haematologist operators and larger numbers of biopsy specimens, and because the arbitrary subdivision of centres according to operator specialty was crude. The skill of individual operators could not be assessed.
Many operators do not obtain adequate bone marrow biopsy specimens from children. Improvement is necessary because this is an invasive investigation, often performed under general anaesthesia. Reporting pathologists are well placed to influence practice by pointing out inadequacies in the specimen and suggesting retraining or even a change in operator. Improvement would almost certainly occur if this investigation was restricted to locally recognised successful operators, whatever their specialty. Most centres should review their practice and devise strategies to improve their ability to obtain adequate cores.
评估从儿童获取足够骨髓环钻活检组织芯的成功率。
对25个中心在五年期间提交的神经母细胞瘤患儿的骨髓环钻活检组织芯切片进行集中评审。对于不含肿瘤的组织芯，处理后保存良好的骨髓长度达0.5厘米被定义为足够。偶尔较小但含有明显肿瘤的组织芯也被视为足够。
在822份活检标本中，139份（17%）不充足。在提交至少20份组织芯的13个中心，失败率在2.6%至50%之间。在研究的五年期间没有改善。提交的组织芯数量与获取足够标本的成功率之间没有实际重要的相关性。尽管当血液科医生而非儿科医生作为主要操作者时，活检标本不充足的发生率较低（分别为13%和29%），但对此不应过度解读，尤其是因为血液科医生作为操作者与更多活检标本数量之间可能存在混淆关联，并且根据操作者专业对中心进行的任意细分很粗略。无法评估个体操作者的技能。
许多操作者未能从儿童获取足够的骨髓活检标本。改进是必要的，因为这是一项侵入性检查，通常在全身麻醉下进行。报告病理学家通过指出标本中的不足之处并建议再培训甚至更换操作者，能够很好地影响实际操作。如果将这项检查限制在当地认可的成功操作者，无论其专业如何，几乎肯定会有所改进。大多数中心应审查其操作并制定策略以提高获取足够组织芯的能力。
