Multisite sampling improves consensus cytologic interpretation in bone marrow evaluation of dogs.

Two-site bone marrow sampling significantly improves diagnostic accuracy compared to single-site sampling in dogs.

This prospective, randomized, masked clinical trial evaluated whether multisite bone marrow (BM) sampling improves cytologic interpretation accuracy in dogs with hematologic disease. Sixteen client-owned dogs underwent four BM aspirates each, collected from the right and left proximal humeri and iliac crests. Individual site interpretations were compared against a composite multisite interpretation serving as the diagnostic truth standard. Single-site sampling yielded a truth-consistent interpretation in only 50.0%–81.7% of cases depending on the level of diagnostic stringency applied. Sampling two sites significantly improved the probability of obtaining a truth-consistent interpretation by 17.2%–23.3% (P < .002), while adding a third or fourth site provided only marginal additional benefit. Inter-clinical pathologist agreement was moderate (kappa = 0.574), highlighting inherent variability in cytologic interpretation. Importantly, no single anatomical site demonstrated superior diagnostic yield over another, suggesting that site selection alone cannot compensate for single-site sampling limitations. These findings support the hypothesis that focal BM lesions occur in dogs, making single-site sampling potentially misleading. The authors conclude that two-site BM sampling should be considered standard practice in dogs requiring BM evaluation, as it substantially improves diagnostic reliability while accounting for focal disease distribution. This has direct implications for clinical decision-making in cases of cytopenias, suspected hematopoietic neoplasia, or other hematologic abnormalities requiring accurate marrow assessment.

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