Blood advances · 2026
Diagnostic Accuracy of Fat Pad Sampling and Bone Marrow Biopsy for AL Amyloidosis: A Systematic Review and Meta-Analysis.
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Azzam Muayad, Kawtharany Hassan, Nazzal Jamil, Hamarsha Qais, Alkhader Aseel, Khraise Tala, AlMasri Mohammad M, Abou Zeid Hadi K, Alwan Iktimal, Jaber Nour, Aguirre Maria Adela, Boedicker Deborah, Bumma Naresh, Carroll Antonia S, Comenzo Raymond, Cook Joselle, Dasgupta Noel R, De La Torre Alfredo, Dispenzieri Angela, Jamal Faizi, Khouri Jack, Leung Nelson, Picken Maria M, Raza Shahzad, Sanchorawala Vaishali, Sarswat Nitasha, Shaikh Hira, Singh Daulath, Seftel Matthew D, Kukreti Vishal, Mustafa Reem A
Аннотация
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.