Percutaneous Conchotome Biopsy of the Deltoid and Quadricep Muscles in the Diagnosis of Neuromuscular Disorders

Abstract

Clinical usefulness and safety of percutaneous conchotome biopsy of the deltoid muscle and of the quadriceps muscle was compared in patients suspected to have a neuromuscular disorder. In 121 samples from the quadriceps muscle and in 39 samples from the deltoid muscle, the quantity of muscle fibers was equal and the fraction of biopsies resulting in a specific diagnosis was similar (50% and 56%, respectively). Also, biopsy from the 2 locations resulted in the same distribution of neurogenic, inflammatory, and myopathic disorders. After quadriceps muscle biopsy, 2 patients developed vasovagal syncopes and one patient a local hematoma, whereas no complications occurred in the patients subjected to deltoid muscle biopsy. We conclude that biopsy from the deltoid muscle is clinically as useful and safe as biopsy from the quadriceps muscle.

Human <em>Vastus Lateralis</em> Skeletal Muscle Biopsy Using the Weil-Blakesley Conchotome

“…After the procedure, thigh stiffness is commonly experienced and can be relieved by gentle exercise (e.g., walking). In the Hertfordshire Sarcopenia Study (HSS), the pain scores measured with the pain visual analogue scale (VAS) (scale from 0 mm -'no pain' to 100 mm -'pain as bad as can be') were typically low with a median of 7 mm during the procedure and 4 mm one day after the procedure suggesting the subjects in this research study found the procedure minimally painful 22 (Materials Table).The rate of wound complications reported in the literature ranges from 1% to 3% and mainly include wound hematoma formation 13,9,14 . One study described a serious a subfascial hematoma and a subsequent deep vein thrombosis 13 .…”

“…It is especially useful for sites where undue pressure could potentially damage neurovascular or underlying bony structures e.g., at the site of the tibialis anterior 15,14 . Muscle yields using the conchotome can be variable and in our practice 20 -200 mg of muscle has been obtained after repeated sampling.…”

“…This method allows controlled tissue penetration with a high degree of maneuverability 13,14 . It is especially useful for sites where undue pressure could potentially damage neurovascular or underlying bony structures e.g., at the site of the tibialis anterior 15,14 .…”

“…It is a simple and safe procedure that can be learned easily. With this technique, muscle suitable for biopsy includes biceps, triceps, deltoid, gastrocnemius, tibialis anterior, soleus and the sacrospinals 17,15,7,18,14 . The outermost part of the vastus lateralis is the most common site used for biopsy as it avoids the main neurovascular structures within the thigh.…”

Percutaneous Muscle Biopsy: History, Methods and Acceptability

“…An alternative instrument to the Bergstrom biopsy needle is the Weil-Blakesley conchotome ( Figure 2) (20)(21)(22). This instrument, designed like a forcep was described by Henriksson in 1979 (21) and consists of a sharp biting tip encompassing a hollow that can vary from 4-6 mm in width.…”