Early diagnosis of systemic amyloidosis by means of a transverse carpal ligament biopsy carried out during carpal tunnel syndrome surgery

Abstract

Introduction and objective: The systematic analysis of a carpal transverse ligament (CTL) sample obtained during routine carpal tunnel syndrome (CTS) surgery may constitute a method of early diagnosis for systemic amyloidosis.

Material and methods: Prospective study carried out on 147 consecutive CTL samples collected from patients intervened for CTS at the University Hospital of León from April 2006 to May 2007. In those cases in which amyloid deposition was observed in the CTL sample, the study was completed with a fine needle aspiration biopsy (FNAB) of the subcutaneous fascia, using the Red Congo stain in both cases. Positive cases were referred to the Internal Medicine and/or Hematology departments, and their evolution was monitored for up to 8 years.

Results: CTL amyloid deposition was observed in 29 patients (19.7%), with a FNAB only being performed in 19 of them (65.5%). The test was positive in 11 cases (57.9%), and 4 patients in this subgroup (3% of the total) developed events attributable to amyloidosis over the following 3 years.

Conclusions: A CTL routine biopsy carried out during CTS surgery may anticipate the systemic amyloidosis diagnosis.

Keywords: Amiloidosis; Amyloidosis; Carpal tunnel syndrome; Diagnóstico precoz; Early diagnosis; Síndrome del túnel del carpo.