Percutaneous Muscle Biopsies: Review of 900 Consecutive Cases at London Health Sciences Centre

Abstract

Muscle biopsies are an important tool in the diagnosis and management of neuromuscular disorders 1,2 . The biopsies can be performed open or by percutaneous means. Open biopsy benefits from the opportunity to directly visualize the muscle, which is typically held in a muscle biopsy clamp which in turn facilitates orientation (for histopathological examination) and maintains the fibres in a fixed length optimal for ultrastructural examination. If necessary, larger samples can be obtained with an open biopsy and the opportunity to sample peripheral nerve exists.Percutaneous (needle) biopsies were likely first performed in the mid 1860's, at which time Charriere and Duchenne described the procedure using a trocar-style instrument 3 . Modern muscle biopsy trocars are similar in design. ABSTRACT:Objective: In the present study we review our experience with 900 consecutive percutaneous muscle biopsies over the period 1993 to 2007. We examined the advantages and limitations of the procedure, biopsy site preferences, diagnostic range, frequency of diagnoses and quality of histopathology. Demographics, referral patterns and patients' perceptions of the procedure were also assessed. Methods: Cases were identified through the London Health Sciences Centre Department of Pathology database. Standard biopsy procedures were followed using a manual trocar style instrument. With a neuropathology technologist in attendance at all biopsies, biopsies were oriented in the fresh state and snap frozen. Results: Most referrals for muscle biopsy were from neuromuscular neurologists. The procedure was found to be efficient, well-tolerated and produced high quality specimens in all diagnostic categories. No major complications occurred. Failure to obtain an adequate tissue sample, although uncommon (<2%), was usually due to marked obesity, edema or muscle wasting. Bleeding at the site was rarely problematic and no wound infections were reported. Conclusions: Needle muscle biopsies represent an efficient alternative to open biopsies when peripheral nerve sampling is not required and when large tissue samples are not needed for extensive biochemical analyses.RÉSUMÉ: Biopsie musculaire percutanée : revue de 900 cas consécutifs au London Health Sciences Centre. Objectif : Nous avons revu notre expérience concernant 900 cas consécutifs de biopsies musculaires percutanées effectuées entre 1993 et 2007. Nous avons examiné les avantages et les limites de cette intervention, l'endroit choisi pour faire la biopsie, la plage diagnostique, la fréquence des diagnostics et la qualité de l'histopathologie. Nous avons également analysé les données démographiques, les modalités de référence et les perceptions des patients concernant l'intervention. Méthodes : Les cas ont été identifiés au moyen de la base de données du département de pathologie du London Health Sciences Centre. Un trocart manuel a été utilisé et la procédure standard de biopsie a été suivie. Un technicien en neuropathologie était présent au moment de chacune des biopsies et il prenait cha...

A Comparison of EMG and Muscle Biopsy in ICU Weakness

“…Direct muscle stimulation was not performed. Muscle biopsies were performed percutaneously as described previously [17].…”

Generation and Use of Cultured Human Primary Myotubes

“…This has the benefits of enabling visualisation of the muscle extract prior to excision and allows for an increase in extract size and/or more controlled sample size in comparison to needle biopsy techniques (Derry et al, 2009;Edwards et al, 1983). In these instances patients are usually under general anaesthetic and a muscle sample is taken from a pre-existing surgical incision, removing the need for an additional surgical incision and superficial trauma.…”

“…In these instances patients are usually under general anaesthetic and a muscle sample is taken from a pre-existing surgical incision, removing the need for an additional surgical incision and superficial trauma. Despite this, it is typically accepted that the needle biopsy procedure presents a more efficient means of obtaining a muscle biopsy (Derry et al, 2009;Edwards et al, 1983). …”

Percutaneous Muscle Biopsy: History, Methods and Acceptability

“…When performed correctly and according to protocol, the semi-open and micro-biopsy techniques result only in minor discomfort for the subject that is qualitatively described as a ''pushing sensation" or a "deep pressure" (29) with very low pain scores (Table 1) (24). Post biopsy, there may be local soreness, stiffness or cramp that do not seem to limit normal activity including recreational sports e.g.…”