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Publications

Journal Article Ahead of print

PubMed: 42696041 DOI: 10.1182/bloodadvances.2026021240

Diagnostic Accuracy of Fat Pad Sampling and Bone Marrow Biopsy for AL Amyloidosis: A Systematic Review and Meta-Analysis.

Blood Adv

Authors: Muayad Azzam, Hassan Kawtharany, Jamil Nazzal, Qais Hamarsha, Aseel Alkhader, Tala Khraise, Mohammad M AlMasri, Hadi K Abou Zeid, Iktimal Alwan, Nour Jaber, Maria Adela Aguirre, Deborah Boedicker, Naresh Bumma, Antonia S Carroll, Raymond Comenzo, Joselle Cook, Noel R Dasgupta, Alfredo De La Torre, Angela Dispenzieri, Faizi Jamal, Jack Khouri, Nelson Leung, Maria M Picken, Shahzad Raza, Vaishali Sanchorawala, Nitasha Sarswat, Hira Shaikh, Daulath Singh, Matthew D Seftel, Vishal Kukreti, Reem A Mustafa

Affiliations

  • University of Kansas Medical Center, Kansas City, Kansas, United States.
  • Saint Louis University School of Medicine, Saint Louis, Missouri, United States.
  • University of Kansas Medical Center, Dalton, Georgia, United States.
  • The University of Kansas Medical Center, Kansas City, Kansas, United States.
  • University of Kansas Medical Center, Kansas city, Kansas, United States.
  • Northwest Health Porter, Valparaiso, Indiana, United States.
  • University of Michigan health sparrow, Lansing, Michigan, United States.
  • Division of Gastroenterology and Hepatology, Wake Forest University School of Medicine, Rochester, North Carolina, United States.
  • AdventHealth, Tampa, Florida, United States.
  • Hospital Italiano de Buenos Aires, BUENOS AIRES, Argentina.
  • Mackenzie's Mission, Reston, Virginia, United States.
  • Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States.
  • St Vincent's Hospital, Sydney, Australia.
  • Tufts Medical Center, Boston, Massachusetts, United States.
  • Mayo Clinic, Rochester, Minnesota, United States.
  • Indiana University School of Medicine, Indianapolis, Indiana, United States.
  • NSHA, Halifax, Nova Scotia, Canada.
  • City of Hope National Medical Center, Duarte, California, United States.
  • Cleveland Clinic, Cleveland, Ohio, United States.
  • Loyola University Medical Centre, Maywood, Illinois, United States.
  • Cleveland Clinic Lerner College of Medicine, Cleveland , OH, Kansas City, Ohio, United States.
  • Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts, United States.
  • The University of Chicago, Chicago, Illinois, United States.
  • Holden Comprehensive Cancer Center, Iowa City, Iowa, United States.
  • Saint Luke's East Hospital, Lee's summit, Missouri, United States.
  • Canadian Blood Services, Vancouver, British Columbia, Canada.
  • Princess Margaret Hospital, Toronto, Canada.

Abstract

In this systematic review, we aimed to assess the diagnostic test accuracy (DTA) of abdominal fat pad sampling and bone marrow biopsy for immunoglobulin light-chain (AL) amyloidosis using organ biopsy as the reference standard. We searched the literature using PubMed, Embase, and CENTRAL databases from inception through March 2024. We used QUADAS-2 to assess the risk of bias and the GRADE approach to assess the certainty of evidence (COE). After deduplication, 29,237 records were screened, and 31 studies were included. Twenty-five studies (n=4,649) reported on fat pad sampling, with a pooled sensitivity of 0.77 (95%CI 0.72-0.81), while twenty studies (n=2,771) reported on bone marrow biopsy, with a pooled sensitivity of 0.55 (0.46-0.63). All studies enrolled patients with confirmed disease, specificity was not reported in the included studies. Fat pad aspiration (15 studies, n=1,590) and surgical or punch biopsy (4 studies, n=222) showed similar sensitivities of 0.80 (0.76-0.83) and 0.77 (0.61-0.88), respectively. In a single study (n=612), performing both tests together yielded a sensitivity of 0.89. COE was judged to be Moderate for fat pad sampling and Low for bone marrow biopsy.

MeSH

Bone Marrow, Biopsy, Amyloidosis, Immunoglobulin Light-Chain Amyloidosis, Hematologic Diseases