Amyloidosis diagnostic study of choice: Difference between revisions

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__NOTOC__
__NOTOC__
{{Amyloidosis}}
{{Amyloidosis}}
{{CMG}}; {{AE}}
{{CMG}} {{shyam}}
 
== Overview ==
== Overview ==
The diagnostic study of choice in amyloidosis is tissue biopsy of the affected organ. Congo red staining will show apple green birefringence of the tissue sample, and subtyping of light chains (for light chain amyloidosis) can be done via mass spectrometry.


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==


=== Study of choice ===
The diagnostic study of choice in amyloidosis is tissue biopsy of the affected organ. Congo red staining will show apple green birefringence of the tissue sample, and subtyping of light chains (for light chain amyloidosis) can be done via mass spectrometry. Mass spectrometry is only applicable to light chain amyloidosis.
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
*'''Tissue biopsy''': A tissue biopsy of the affected organ is the gold standard test for amyloidosis. Particular stains can determine the subtype of amyloidosis.
* The following result of [gold standard test] is confirmatory of [disease name]:
*'''Bone marrow biopsy''': A bone marrow biopsy is commonly done in patients who have light chain amyloidosis and suspected concurrent [[multiple myeloma]].<ref name="pmid24145344">{{cite journal| author=Kourelis TV, Kumar SK, Gertz MA, Lacy MQ, Buadi FK, Hayman SR et al.| title=Coexistent multiple myeloma or increased bone marrow plasma cells define equally high-risk populations in patients with immunoglobulin light chain amyloidosis. | journal=J Clin Oncol | year= 2013 | volume= 31 | issue= 34 | pages= 4319-24 | pmid=24145344 | doi=10.1200/JCO.2013.50.8499 | pmc=4881366 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24145344  }} </ref>
** Result 1
*'''Organ-specific labs''': If a particular organ is affected, laboratory measurements that are specific to that organ can be measured. For example, if there is liver involvement, liver function tests (such as AST, ALT, total bilirubin, and alkaline phosphatase) should be measured.<ref name="pmid24497558">{{cite journal| author=Mahmood S, Palladini G, Sanchorawala V, Wechalekar A| title=Update on treatment of light chain amyloidosis. | journal=Haematologica | year= 2014 | volume= 99 | issue= 2 | pages= 209-21 | pmid=24497558 | doi=10.3324/haematol.2013.087619 | pmc=3912950 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24497558  }} </ref>
** Result 2
* The [name of the investigation] should be performed when:
** The patient presented with symptoms/signs 1. 2, 3.
** A positive [test] is detected in the patient.
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* The diagnostic study of choice for [disease name] is [name of the investigation].
* There is no single diagnostic study of choice for the diagnosis of [disease name].
* There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
* [Disease name] is mainly diagnosed based on clinical presentation.
* Investigations:
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
 
==== The comparison of various diagnostic studies for [disease name] ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
|}
<small> ✔= The best test based on the feature </small>
 
===== Diagnostic results =====
The following result of [investigation name] is confirmatory of [disease name]:
* Result 1
* Result 2
 
===== Sequence of Diagnostic Studies =====
The [name of investigation] should be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
 
=== Diagnostic Criteria ===
* Here you should describe the details of the diagnostic criteria.
*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for the diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
 
* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
** Criteria 1
** Criteria 2
** Criteria 3


IF there are clear, established diagnostic criteria:
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria: 
*There are no established criteria for the diagnosis of [disease name].




Revision as of 18:15, 2 January 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2]

Overview

The diagnostic study of choice in amyloidosis is tissue biopsy of the affected organ. Congo red staining will show apple green birefringence of the tissue sample, and subtyping of light chains (for light chain amyloidosis) can be done via mass spectrometry.

Diagnostic Study of Choice

The diagnostic study of choice in amyloidosis is tissue biopsy of the affected organ. Congo red staining will show apple green birefringence of the tissue sample, and subtyping of light chains (for light chain amyloidosis) can be done via mass spectrometry. Mass spectrometry is only applicable to light chain amyloidosis.

  • Tissue biopsy: A tissue biopsy of the affected organ is the gold standard test for amyloidosis. Particular stains can determine the subtype of amyloidosis.
  • Bone marrow biopsy: A bone marrow biopsy is commonly done in patients who have light chain amyloidosis and suspected concurrent multiple myeloma.[1]
  • Organ-specific labs: If a particular organ is affected, laboratory measurements that are specific to that organ can be measured. For example, if there is liver involvement, liver function tests (such as AST, ALT, total bilirubin, and alkaline phosphatase) should be measured.[2]


References

  1. ↑ Kourelis TV, Kumar SK, Gertz MA, Lacy MQ, Buadi FK, Hayman SR; et al. (2013). "Coexistent multiple myeloma or increased bone marrow plasma cells define equally high-risk populations in patients with immunoglobulin light chain amyloidosis". J Clin Oncol. 31 (34): 4319–24. doi:10.1200/JCO.2013.50.8499. PMC 4881366. PMID 24145344.
  2. ↑ Mahmood S, Palladini G, Sanchorawala V, Wechalekar A (2014). "Update on treatment of light chain amyloidosis". Haematologica. 99 (2): 209–21. doi:10.3324/haematol.2013.087619. PMC 3912950. PMID 24497558.

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