Biopsies and sampling

Bone marrow aspiration or biopsy
  • A bone marrow aspiration/biopsy involves withdrawing a sample of liquid/tissue from the bone marrow at the centre of a bone. This is usually from the hip bone.

Bone marrow aspirations and biopsies can show the presence of the leukaemia cells in the bone marrow. This can confirm the diagnosis of CLL.

Bone marrow samples are usually taken from the hip bone under local anaesthetic using special biopsy needles:

  • Bone marrow aspirations are usually done first
  • After a small cutaneous incision, a hollow needle is inserted through the hip bone and into the bone marrow.
  • A syringe attached to the needle is used to aspirate a sample of the liquid portion of the bone marrow (Figure).
  • The aspiration only takes a few minutes.
  • Bone marrow biopsies are done subsequently
  • They are performed using a larger surgical needle with a cylindrical blade, called trephine.
  • They remove a 1 or 2 cm core of bone marrow in one piece.
  • At the end of the procedures, the needles are removed and a small plaster or dressing applied.

Figure             Bone marrow biopsy

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Lymph node biopsy
  • A lymph node biopsy requires taking a sample from a lymph node (or sometimes the whole lymph node) for testing.
  • Examination of the biopsy will invariably show the presence of leukaemia cells confirming a CLL diagnosis.
Lumbar puncture
  • A lumbar puncture consists of taking a small sample of cerebrospinal fluid (CSF). This is achieved by inserting a thin needle between two vertebrae in the lower part of the spine.
  • Analysis of the CSF can determine the presence of leukaemia cells in the central nervous system (CNS).
  • Lumbar puncture with analysis of the obtained CSF is important to determine if leukaemia cells have penetrated the CNS. If leukaemia cells are present in the CNS, patients will need additional treatment straight after diagnosis.
  • Patients are asked to lie on their side with their legs pulled up and tucked under the chin. This position makes it easier for the doctor or nurse to insert the needle between the vertebrae.
  • The skin over the vertebrae is cleaned and the area numbed with a local anaesthetic. A thin aspiration needle is inserted between the L4 and L5 vertebrae in the lower part of the spine (Figure). The patient should not be in pain, but might feel some pressure.
  • At the end of the procedure, the needle is removed and a small plaster or dressing applied.

Figure            Lumbar puncture and collection of CSF for analysis

Courtesy of Medical gallery of Blausen (