Rapid, point-of-care bone marrow aspirate adequacy assessment via deep ultraviolet microscopy.

Abstract

Bone marrow aspirations are pivotal for diagnosing and monitoring various hematological conditions, including cancers. However, a significant portion (10-50%) of aspirations yield suboptimal or inadequate diagnostic material. The difficulty and scarcity of bedside adequacy assessment strategies further exacerbate the challenges in this procedure, which can consequently lead to delays in diagnosis and treatment, among other complications. To address this unmet clinical need, we apply deep ultraviolet (UV) microscopy, a real-time, low-cost, label-free molecular imaging technology that recapitulates the appearance of Giemsa stains. We present results from a prospective clinical study comprising 51 pediatric oncology patients, where the deep UV images of unstained bone marrow aspirate smears are evaluated and compared to the clinical standard-of-care (a hematopathologist inspection of the same slides after Giemsa-staining). Results show that both real-time UV visual inspection and an automated classification algorithm applied to the unstained deep UV images achieve accurate adequacy assessment, with accuracies of 94.1% and 95.7%, respectively. Additionally, we demonstrate whole slide imaging of bone marrow aspirate smears using a compact and low-cost deep UV microscope that is well-suited for point-of-care use. Together, this work has significant implications for improving bone marrow aspirations and the clinical management of many hematological patients.