The pathological diagnosis of nerve biopsies: a practical approach

Brandner, Sebastian

doi:10.1016/j.mpdhp.2016.08.001

Cited by 4 publications

(5 citation statements)

References 36 publications

(30 reference statements)

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“…For distal nerves, whole nerve biopsy is preferable to fascicular biopsy as the two approaches do not significantly differ in terms of post‐operative pain or other complications 17 . It is recommended that 4‐5 cm of nerve be removed for sufficient diagnostic value, noting that the post‐biopsy neurological deficit is independent of specimen length 21,22 …”

Section: Methodsmentioning

confidence: 99%

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Nerve biopsy: Current indications and decision tools

et al. 2021

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After initial investigation of patients presenting with symptoms suggestive of neuropathy, a clinical decision is made for a minority of patients to undergo further assessment with nerve biopsy. Many nerve biopsies do not demonstrate a definitive pathological diagnosis and there is considerable cost and morbidity associated with the procedure. This highlights the need for appropriate selection of patients, nerves and neuropathology techniques. Additionally, concomitant muscle and skin biopsies may improve the diagnostic yield in some cases. Several advances have been made in diagnostics in recent years, particularly in genomics. The indications for nerve biopsy have consequently changed over time. This review explores the current indications for nerve biopsies and some of the issues surrounding its use. Also included are comments on alternative diagnostic modalities that may help to supplant or reduce the use of nerve biopsy as a diagnostic test. These primarily include extraneural biopsy and neuroimaging techniques such as magnetic resonance neurography and nerve ultrasound. Finally, we propose an algorithm to assist in deciding when to perform nerve biopsies.

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Section: Methodsmentioning

confidence: 99%

“… 17 It is recommended that 4‐5 cm of nerve be removed for sufficient diagnostic value, noting that the post‐biopsy neurological deficit is independent of specimen length. 21 , 22 …”

Section: Methodsmentioning

confidence: 99%

Nerve biopsy: Current indications and decision tools

et al. 2021

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“…Vasculitic neuropathy is an inflammatory process that damages the vasa nervorum, affecting the associated axon with ischemic sequelae . Its presentation ranges from acute to chronic . Vasculitic neuropathy occurring as part of a primary systemic vasculitis or considered to be secondary to systemic autoimmune conditions, infections, malignancy, and some drugs is termed systemic vasculitic neuropathy.…”

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confidence: 99%

“…1 Its presentation ranges from acute to chronic. 2 Vasculitic neuropathy occurring as part of a primary systemic vasculitis or considered to be secondary to systemic autoimmune conditions, infections, malignancy, and some drugs is termed systemic vasculitic neuropathy. Less common is nonsystemic vasculitic neuropathy (NSVN), where vasculitis is isolated to the peripheral nerves.…”

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confidence: 99%

Vasculitic neuropathy: Comparison of clinical predictors with histopathological outcome

et al. 2019

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Introduction:To improve diagnostic accuracy, in this study we compared prebiopsy clinical parameters with subsequent pathological confirmation of peripheral nerve vasculitis. Methods: Clinical, laboratory, and neurophysiological parameters were analyzed for consecutive patients referred for nerve biopsy with suspected vasculitis. Patients were assigned pathological categories of definite, probable, possible, or absent vasculitis using validated guidelines. Patients with definite or probable vasculitis were considered to have pathologically confirmed vasculitis. Results: From a cohort of 78 patients, biopsy confirmed vasculitis in 29.5%. Parameters that best differentiated between pathologically confirmed and pathologically unlikely vasculitis were stepwise clinical progression (34.8% vs. 5.6%), the presence of serum anti‐myeloperoxidase antibody (28.6% vs. 2.2%) and rheumatoid factor seropositivity (38.1% vs. 10.7%). Pathologically absent vasculitis was frequent in patients with normal (100%) or primarily demyelinating (87.5%) nerve conduction studies. Discussion: Factoring the negative predictors of pathologically confirmed vasculitis into decision‐making can reduce the frequency of diagnostically unhelpful nerve biopsies. Muscle Nerve 59:643–649, 2019

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“…Structural and compositional changes associated with nerve damage, such as edema and fibrotic scarring, are known both to alter nerve mechanical properties and to cause nerve enlargement . In unimpaired nerves, although there are differences in structure and composition, this variability is not comparable to that of damaged nerves . Differences in nerve size along the limb in unimpaired nerves are predominately a result of less drastic changes, such as proximodistal branching .…”

Section: Discussionmentioning

confidence: 99%

Influence of limb position on assessment of nerve mechanical properties by using shear wave ultrasound elastography

2020

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Introduction: Evaluation of nerve mechanical properties has the potential to improve assessment of nerve impairment. Shear wave velocity, as measured by using shear wave (SW) ultrasound elastography, is a promising indicator of nerve mechanical properties such as stiffness. However, elucidation of external factors that influence SW velocity, particularly nerve tension, is required for accurate interpretations.Methods: Median and ulnar nerve SW velocities were measured at proximal and distal locations with limb positions that indirectly altered nerve tension.Results: Shear wave velocity was greater at proximal and distal locations for limb positions that induced greater tension in the median (mean increase proximal 89.3%, distal 64%) and ulnar (mean increase proximal 91.1%, distal 37.4%) nerves.Discussion: Due to the influence of nerve tension when SW ultrasound elastography is used, careful consideration must be given to limb positioning. K E Y W O R D S mechanical properties, nerve cross-sectional area, neuromuscular ultrasound, peripheral nerve, shear wave ultrasound elastography, tension

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The pathological diagnosis of nerve biopsies: a practical approach

Cited by 4 publications

References 36 publications

Nerve biopsy: Current indications and decision tools

Nerve biopsy: Current indications and decision tools

Vasculitic neuropathy: Comparison of clinical predictors with histopathological outcome

Influence of limb position on assessment of nerve mechanical properties by using shear wave ultrasound elastography

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