Table 6.

Consensus statements on biopsy in clinical practice.

Barriers to accurate evaluation of samples obtained from biopsies	Cardiology consensus rate %*
There are technical deficiencies in defining the pathological characterization of CA biopsy samples in Turkey (regarding the sensitivity and limitations in the dye portfolio and unavailability of mass spectrometric analysis of biopsy specimens.)	100
Recommendations on when to use biopsy in aTTR-CM diagnosis	Cardiology Consensus Rate %*
An endomyocardial/extracardiac biopsy can be performed*, in a patient with suspected CAa, whose cardiac scintigraphy showed a discordant/inconclusive finding on radiotracer uptake for aTTR-CM or if scintigraphy results were negative (Grade ≥ 2 with H/CL <1.5, or Grade1 or Grade 0) assessed by SPECT or SPECT-CT, while CMR findings and/or detailed echocardiographic scoring is supporting the presence of a CA.	80
There is no need for a cardiac biopsy in clinics where non-invasive diagnostic tools for aTTR-CM are available due to the risks for the patient and the barriers in evaluation.	100
If biopsy is required to diagnose CA, extracardiac biopsies should be performed as the primary method.	100
For extracardiac biopsies, the sample may be obtained from abdominal fat tissue initially, then from the minor salivary gland or rectum if no results are obtained with the initial approach.	100

^*If the patient's condition and evaluation capability of the unit are both suitable.

^a Based on clinical, ECG, and ECO findings.