Improving bone marrow biopsy core length and aspirate adequacy through implementation of a powered device: A single-institution quality improvement initiative

Abstract Background: Adequate bone marrow (BM) examination is essential for diagnosing, staging, and monitoring hematologic disorders. Suboptimal BM samples can compromise diagnostic accuracy, necessitate repeat procedures, increase patient anxiety, and delay treatment. We conducted a quality improvement (QI) project to assess baseline BM biopsy core length and aspirate adequacy, identify factors associated with suboptimal samples, and implement interventions to enhance specimen quality. Methods: We retrospectively analyzed 104 BM biopsies performed at our institution between August 2024 and January 2025. Data collected included patient age, gender, body mass index (BMI), sedation status, procedure setting (inpatient versus outpatient), biopsy indication, pre-processing BM core length, and aspirate adequacy. A multidisciplinary QI team reviewed the data and identified high-impact, feasible interventions using an impact-effort matrix. At baseline, all samples were obtained manually using a Jamshidi needle. The use of a powered biopsy device was selected as a high-impact intervention. Following implementation, post-intervention data were collected. Statistical significance was assessed using independent samples t-tests and chi-square tests (p value <0.05 is considered statistically significant). Results: Of the 104 baseline samples, 55 (52%) were from male patients; the median age was 67 years. Most biopsies (88, 84%) were performed in the outpatient setting. Common indications included plasma cell disorders (33%) and myeloid neoplasms (37%). The mean BM core length was 9.4 mm, and 76 samples (73%) were deemed adequate for histologic evaluation. BM aspirates were adequate in 75 cases (72.1%). Following implementation of the powered device, 47 consecutive BM biopsies were analyzed. Of these, 23 (48%) were from male patients; the median age was 69 years. The mean BM core length increased to 13.6 mm, with 40 samples (85%) adequate for evaluation. BM aspirates were adequate in 42 cases (89.3%). Use of the powered device significantly increased the mean core length by 4.19 mm (95% CI: 2.3–6.09, p < 0.001). Aspirate adequacy also improved significantly, from 72.1% to 89.3% (p = 0.019, chi-square test). Repeat procedures due to inadequate diagnostic material decreased from three in the Jamshidi group (n = 104) to none in the powered device group (n = 47). For patients with BMI >25, the powered device significantly increased core length by 5.42 mm (95% CI: 2.7–7.2; p < 0.001), and aspirate adequacy improved from 72.6% to 87.5%. In patients with BMI <25, the increase in core length (2.4 mm) was identified but not statistically significant (95% CI: -1.2–6.05; p = 0.191). Utilization of the powered device demonstrated superior performance particularly in the higher BMI subgroup. Conclusion: The implementation of a powered biopsy device significantly improved BM core length and aspirate adequacy, particularly among patients with higher BMI. This QI initiative highlights the clinical value of adopting powered devices to enhance specimen quality and reduce the need for repeat procedures in hematologic assessments. As a next step, we plan to expand this project to assess patient-reported outcomes, including post-procedure pain scores and potential differences in complication rates between biopsy techniques.