Peripheral Nerve Society Guideline on processing and evaluation of nerve biopsies

Abstract

Nerve biopsy is often the final step in the diagnostic work-up of neuropathies of unknown origin. The aim of this guideline was to prepare an evidence-based guideline on the methods for performing and evaluating nerve biopsy. The panel performed a search of MEDLINE, hand search of bibliographies of the references retrieved, review of the evidence, and reached agreement by consensus. There were not enough formal studies of diagnostic test accuracy to allow evidence-based recommendations of levels A-C for most questions. The panel summarized the class IV evidence and reached agreement by consensus on the following recommendations: (1) Nerve biopsy should not be performed before adequate clinical, electrophysiological, and laboratory investigation and only be performed with appropriate informed consent. (2) An interactive working relationship with the relevant disciplines involved and the provision of sufficient clinical information is encouraged. (3) Biopsies should be processed and read by professionals with adequate training and experience. (4) Optimal analysis of nerve biopsy is best performed by laboratories that have the facilities and expertise to prepare and evaluate frozen and fixed sections (cryostat, paraffin, and epoxy sections). (5) Immunohistochemistry, teased fiber analysis, electron microscopy, and morphometry may help clarify the diagnosis in some conditions and should be considered as additional studies.

Processing of nerve biopsies: A practical guide for neuropathologists

“…In our experience, and based on the results published by others, nerve biopsy can be diagnostically helpful and valuable as part of the therapeutic decision making process, especially if inflammation or other interstitial pathology such as vasculitis, granulomatous inflammation, amyloidosis or atypical CIDP is suspected [2, 3, 12]. In the usual clinical setting, the major rationale to perform a nerve biopsy is to gain information about therapeutic options when inflammatory neuropathy is considered.…”

“…It is based on recently published guidelines [2, 3], contemporary reviews [4, 5, 6], textbooks including [7, 8, 9, 10, 11], and the personal experience of its authors. …”

Dynamic Transcriptional Events in Distal Sural Nerve Revealed by Transcriptome Analysis

“…The transcript levels were calculated and the relative transcript abundances were measured in fragments per kilobase of exon per million fragments mapped (FPKM) using Cufflinks (http://cufflinks.cbcb.umd.edu/index.html). The deFuse program (version 0.4.3, http://sourceforge.net/apps/mediawiki/defuse) was used to identify gene fusions from the RNA-Seq data because this program considered all alignments and all possible locations for fusion boundaries [9]. …”

Clinical Neuropathology practice guide 3-2014: Combined nerve and muscle biopsy in the diagnostic workup of neuropathy – the Bordeaux experience

“…Several books were devoted to pathology on nerve biopsy [1, 2, 3, 4, 5, 6] and were followed by several papers [7, 8, 9, 10]. Simultaneous combined superficial peroneal nerve and peroneous brevis muscle biopsy may be chosen on purpose because it allows examination of several specimens and significantly improves the diagnosis of systemic diseases with peripheral nerve involvement.…”