Interventional Oncology
Alex Podlaski, MD
Resident
Rush
Jordan Tasse, MD
Associate Professor, Vascular and Interventional Radiology
Rush University Medical Center
Bulent Arslan, MD FSIR
Professor and Chair, Vascular and Interventional Service Line
Rush University Medical Center
Ulku C. Turba, MD FSIR
Professor, Vascular and Interventional Radiology
RUSH University Medical Center
David Tabriz, MD, RPVI
Assistant Professor of Radiology
Rush University
Rehan Riaz, MD
Assistant Professor of Radiology
Rush University Medical Center
Sreekumar Madassery, MD
Associate Professor, Vascular and Interventional Service Line
Rush University Medical Center
To describe an alternative supine approach for image guided bone marrow biopsy, which is not commonly considered. Bone marrow aspiration & biopsy is commonly utilized for evaluation of hematologic/non-hematologic malignancies, treatment response and metabolic abnormalities. Historically this was performed at bedside and eventually in the interventional suite with CT guidance. However, due to the limited availability there has been a push for fluoroscopic guided procedures. Typically, the procedure is performed in the prone position, targeting the posterior ilium, however this may be limited in patients with a large body habitus, positional discomfort, medical co-morbidities and anesthesia needs. To our knowledge, detailed description and outcomes of fluoroscopic biopsies in the supine position have not been published.
Materials and Methods:
Retrospective review was performed of all image guided bone marrow biopsy cases performed at our institution in the Interventional Radiology department between 2012-2022, filtered using dictation software search engine analysis. All bone marrow aspirations and biopsies were performed using the OnControl bone access system. Biopsies, regardless of imaging modality were reviewed, and evaluated for patient positioning, sample adequacy and reported results.
Results:
1402 image guided bone marrow aspiration & biopsies were performed. 191 were fluoroscopic guided, with the remainder being under CT guidance. Of the fluoroscopic interventions, 48 were supine with targeting of the anterior iliac crest, in the ipsilateral projection. Patient age ranged from 28-83yo. Male to Female ratio was 25 to 23 respectively. Of the supine approach patients, there were no instances of inadequate samples on visual inspection by certified pathology staff in the room, or upon final pathologic analysis. No differences in core sample length, diameter or number of passes were present compared to the prone position or CT guidance. There were no minor or major complications.
Conclusion:
Anterior fluoroscopic bone marrow biopsy is an approach that has not been described in the literature and can be safely performed with no differences in the results or complications from conventional approaches. Given the increase in volume of these procedures performed by interventionalists an alternative approach may be necessary in an increasing population of patients with obesity, advanced medial comorbidities, demands for sedation/anesthesia and decreasing CT availability.