Effects of the Use of a Mallet during Bone Marrow Biopsy Collection on Specimen Quality: A Quality Improvement Project.

Context: Avoiding procedure-related morphologic distortion such as fragmentation and crush artifact is critical in bone marrow diagnosis. Use of a hammer or mallet, although infrequent, is a known technique of advancing the biopsy needle during specimen collection.

Objectives: We performed a double-blinded, retrospective review of bone marrow biopsies collected by the Interventional Radiology department at our institution in order to assess specimen quality by using this technique.

Design: We reviewed 93 bone marrow biopsy specimens collected at our hospitals, between January 2015 and June 2015. Routine bone marrow core biopsy slides were reviewed. The presence of crush artifact, specimen fragmentation, and aspiration artifact, as well as the presence of osteopenia and an overall grade of specimen adequacy, was recorded for each specimen.

Results: A sterile mallet was used during the bone marrow biopsy procedure in 29 cases. Use of a mallet was significantly associated with the presence of suboptimal or inadequate specimen quality of bone marrow core biopsy (<0.005) and was independently associated with severe specimen fragmentation (2+) (<0.0001). There was no statistically significant association between length of the core and use of a mallet.

Conclusions: Use of a mallet during bone marrow core biopsy collection is significantly associated with morphologic distortion in the form of severe specimen fragmentation and negatively affects specimen adequacy. There is no difference in length of core biopsy as previously thought by using a mallet to advance the needle during the procedure. We recommend that the use of this technique should be avoided during specimen collection.