Amyloidosis Center, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA.
Amyloid. 2023 Sep;30(3):297-302. doi: 10.1080/13506129.2023.2171787. Epub 2023 Jan 31.
Diagnostic algorithms for amyloidosis have evolved over the past decade, particularly with the incorporation of imaging-based techniques to detect amyloid cardiomyopathy. We sought to identify the key sources of amyloidosis misidentification in the community, which lead to false positive referrals to a tertiary centre.
We conducted a retrospective review of all referrals to the Amyloidosis Centre from 2010 to 2021 and identified cases lacking amyloid pathology upon final adjudication after extensive assessment at the centre. Factors for false positive referrals were examined.
Among 2409 referrals of suspected amyloidosis, 147 (6%) demonstrated an absence of amyloid pathology. This percentage increased over time from 4% in 2010 to 13% in 2021. False positive referrals consisted of more people of colour. The most frequent source of inaccuracy was the erroneous staining of tissue specimens with Congo red, followed by suggestive findings on cardiac imaging. In recent years, misinterpretation of technetium- pyrophosphate scintigraphy emerged as a major source of false positive referrals.
Recognising these potential sources of diagnostic error in the workup of amyloidosis can improve patient care. Referral to a centre of excellence for amyloidosis helps confirm an accurate diagnosis and avoid mistreatment.
在过去十年中，淀粉样变性的诊断算法不断发展，特别是纳入了基于影像学的技术来检测淀粉样心肌病。我们试图确定社区中淀粉样变性误诊的主要原因，这些原因导致向三级中心进行了错误的阳性转诊。
我们对 2010 年至 2021 年期间向淀粉样变性中心转诊的所有患者进行了回顾性分析，并在中心进行了广泛评估后，确定了最终判断为缺乏淀粉样变性病理的病例。检查了导致假阳性转诊的因素。
在 2409 例疑似淀粉样变性的转诊患者中，有 147 例（6%）未发现淀粉样变性病理。这一比例随着时间的推移从 2010 年的 4%增加到 2021 年的 13%。假阳性转诊患者中更多为有色人种。最常见的不准确原因是刚果红错误染色组织标本，其次是心脏影像学上的提示性发现。近年来，锝-焦磷酸盐闪烁扫描术的错误解读已成为假阳性转诊的主要原因之一。
认识到淀粉样变性诊断过程中这些潜在的诊断错误来源，可以改善患者的治疗效果。向淀粉样变性卓越中心转诊有助于确认准确的诊断并避免误诊。
