The Journal of hand surgery · 2025
Development of an Amyloidosis Risk Score for Positive Tenosynovial Biopsy at Carpal Tunnel Release.
СтатьяНазвание и аннотация: Перевод в очереди
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Zhang Dafang, Earp Brandon E, Benavent Kyra A, Chang Yuchiao, Cuddy Sarah, Dyer George S M, Falk Rodney H, Katz Jeffrey N, Mitchell Richard N, Padera Robert F, Blazar Philip
Аннотация
PURPOSE: Tenosynovial biopsy at the time of carpal tunnel release affords a unique opportunity for the early diagnosis of amyloidosis. We aimed to build a risk score to stratify patients likely to have undiagnosed amyloidosis.
METHODS: We conducted a prospective cohort study of 320 adult patients with carpal tunnel syndrome undergoing carpal tunnel release. Patients underwent tenosynovial biopsy at the time of surgery. The primary outcome measure was a positive biopsy for amyloid deposition as assessed by Congo red and sulfated Alcian blue staining. We generated a risk score by assigning points to each variable independently associated with a positive biopsy in a logistic regression model, with weights proportional to parameter estimates (log odds ratio).
RESULTS: The cohort mean age was 63 years, and 65% were female. Forty-nine out of 320 subjects (15.3%) had positive tenosynovial biopsies for amyloidosis. In the logistic regression model, independent predictors of a positive biopsy included age 70 to 79 years (odds ratio [OR] 14.6, 95% confidence interval [CI] 1.83-115.7) and age ≥ 80 years (OR 33.9, 95% CI 4.1-279.3) compared with age < 50 years, male sex (OR 2.6, 95% CI 1.3-5.3), and history of trigger digit (OR 2.4, 95% CI 1.2-4.9). We assigned weights proportional to the log odds ratios from the logistic model to generate a summary amyloidosis risk score based on age, sex, and history of trigger digit. A score of 0 corresponds to 2.5% risk and 6 to 75% risk.
CONCLUSIONS: The likelihood of a positive biopsy for amyloidosis is independently associated with older age, male sex, and history of trigger digit.
CLINICAL RELEVANCE: A routine biopsy strategy maximizes sensitivity for the early detection of amyloidosis with a 15% positive biopsy rate. We furthermore present a risk score for a selective biopsy strategies with associated sensitivities and specificities.
METHODS: We conducted a prospective cohort study of 320 adult patients with carpal tunnel syndrome undergoing carpal tunnel release. Patients underwent tenosynovial biopsy at the time of surgery. The primary outcome measure was a positive biopsy for amyloid deposition as assessed by Congo red and sulfated Alcian blue staining. We generated a risk score by assigning points to each variable independently associated with a positive biopsy in a logistic regression model, with weights proportional to parameter estimates (log odds ratio).
RESULTS: The cohort mean age was 63 years, and 65% were female. Forty-nine out of 320 subjects (15.3%) had positive tenosynovial biopsies for amyloidosis. In the logistic regression model, independent predictors of a positive biopsy included age 70 to 79 years (odds ratio [OR] 14.6, 95% confidence interval [CI] 1.83-115.7) and age ≥ 80 years (OR 33.9, 95% CI 4.1-279.3) compared with age < 50 years, male sex (OR 2.6, 95% CI 1.3-5.3), and history of trigger digit (OR 2.4, 95% CI 1.2-4.9). We assigned weights proportional to the log odds ratios from the logistic model to generate a summary amyloidosis risk score based on age, sex, and history of trigger digit. A score of 0 corresponds to 2.5% risk and 6 to 75% risk.
CONCLUSIONS: The likelihood of a positive biopsy for amyloidosis is independently associated with older age, male sex, and history of trigger digit.
CLINICAL RELEVANCE: A routine biopsy strategy maximizes sensitivity for the early detection of amyloidosis with a 15% positive biopsy rate. We furthermore present a risk score for a selective biopsy strategies with associated sensitivities and specificities.