Diagnostic Accuracy of Fat Pad Sampling and Bone Marrow Biopsy for AL Amyloidosis: A Systematic Review and Meta-Analysis
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.
Authors
- Angela Dispenzieri (ORCID: https://orcid.org/0000-0001-8780-9512)
- Matthew D. Seftel (ORCID: https://orcid.org/0000-0002-0960-2687)
- Jack Khouri (ORCID: https://orcid.org/0000-0002-2473-6528)
- María Adela Aguirre (ORCID: https://orcid.org/0000-0001-9690-2284)
- Vaishali Sanchorawala (ORCID: https://orcid.org/0000-0002-6307-2445)
- Nelson Leung (ORCID: https://orcid.org/0000-0002-5651-1411)
- Antonia Carroll (ORCID: https://orcid.org/0000-0002-1738-9580)
- Muayad Azzam (ORCID: https://orcid.org/0000-0002-2046-8343)
- Naresh Bumma
- Aseel Alkhader
- Jamil Nazzal
- Shahzad Raza (ORCID: https://orcid.org/0000-0002-2739-2265)
- Hadi Khaled Abou Zeid (ORCID: https://orcid.org/0000-0002-5111-3043)
- Nitasha Sarswat (ORCID: https://orcid.org/0000-0003-0233-7881)
- Joselle Cook (ORCID: https://orcid.org/0000-0001-5335-9533)
- Reem A. Mustafa (ORCID: https://orcid.org/0000-0002-2091-0875)
- Daulath Singh (ORCID: https://orcid.org/0000-0002-0346-8501)
- Maria M. Picken (ORCID: https://orcid.org/0000-0002-8065-6178)
- Deborah Boedicker (ORCID: https://orcid.org/0000-0001-7254-4654)
- Hassan Kawtharany (ORCID: https://orcid.org/0009-0007-3725-8485)
- Faizi Jamal (ORCID: https://orcid.org/0009-0009-5459-3431)
- Iktimal Alwan
- Tala Khraise
- Nour Jaber
- Mohammad M. AlMasri
- Hira Shaikh
- Alfredo De La Torre
- Raymond Comenzo
- Qais Hamarsha (ORCID: https://orcid.org/0000-0001-9711-4650)
- Vishal Kukreti
- Noel R Dasgupta
Institutions
- Boston University (US)
- Boston Medical Center (US)
- Tufts Medical Center (US)
- City Of Hope National Medical Center (US)
- Loyola University Medical Center (US)
- Sparrow Health System (US)
- Cleveland Clinic (US)
- Mayo Clinic (US)
- Valparaiso University (US)
- Universidade Presbiteriana Mackenzie (BR)
- Sparrow Hospital (US)
- Hospital Italiano de Buenos Aires (AR)
- Princess Margaret Cancer Centre (CA)
- Cleveland Clinic Lerner College of Medicine (US)
- University of Chicago (US)
- St Vincent's Hospital Sydney (AU)
- Greenfield Research (Canada) (CA)
- University of Kansas Medical Center (US)
- Hamilton Medical Center (US)
- AdventHealth Tampa (US)
- Saint Luke's East Hospital (US)
- Iowa City Public Library (US)
- Indiana University School of Medicine
- NSCAD University (CA)
- Wake Forest University (US)
- Saint Louis University (US)
- The Ohio State University (US)
- Indiana University – Purdue University Indianapolis (US)
- Canadian Blood Services (CA)
Publication Details
- Journal
- Blood Advances
- Published
- 2026-09-04
- DOI
- https://doi.org/10.1182/bloodadvances.2026021240
- Primary Topic
- Amyloidosis: Diagnosis, Treatment, Outcomes
- Type
- article
- Field-Weighted Citation Impact
- 0.00