Evaluation of simultaneous muscle and nerve biopsies for the diagnosis of neuromuscular diseases

Chen, Derrick J.; Prayson, Richard A.

doi:10.1016/j.anndiagpath.2014.08.001

Cited by 4 publications

(9 citation statements)

References 10 publications

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“…The diagnostic yield of muscle biopsies, as reported in the literature, ranges from 30-70% [ 3 , 6 , 8 - 11 ]. Careful preoperative consideration of factors that might improve diagnostic yield would be in the best interests of patients by facilitating identification of patients who are likely to benefit from biopsy and excluding from biopsy procedures those patients who are unlikely to have a diagnostic result.…”

Section: Discussionmentioning

confidence: 99%

“…The diversity of sources of referrals for muscle biopsy reflects the heterogeneity of specialties taking care of patients with myopathy and myopathic-like processes. Published reports describe mainly what types of pre-biopsy evaluations have been conducted without considering the specialty of the provider who supervised the evaluation [ 1 , 3 , 5 - 8 , 12 , 13 ]. Different specialties tend to take different approaches to evaluation of myopathies and related processes, so the nature and extent of the preoperative evaluation can vary widely and could be expected to influence the likelihood of obtaining a diagnostically and/or therapeutically useful muscle biopsy result.…”

Section: Discussionmentioning

confidence: 99%

“…Secondary causes of myopathies occur due to neurogenic disease [ 2 ]. Work up for myopathy includes history, physical examination, imaging, laboratory, and electromyographic testing [ 3 - 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…If a diagnosis cannot be established with other clinical means then the gold standard is a muscle biopsy [ 6 - 7 ]. A muscle biopsy has an estimated diagnostic yield of 30%–70% [ 3 , 6 , 8 - 11 ]. Muscle biopsy is a relatively minor procedure, but it has inherent risks including hematoma, muscle herniation, infection, wound dehiscence, pain, and weakness, in addition to the risk of being non-diagnostic [ 4 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, care should be taken to identify and refer those patients who are likely to derive therapeutic benefit from the procedure while refraining from referring those patients who are unlikely to benefit. A variety of factors may play a role in determining the predictive value of a diagnostic muscle biopsy [ 1 , 3 , 5 - 8 , 12 ] or therapeutic impact of the biopsy affecting treatment [ 6 , 8 , 10 ]. To date, the literature has not examined the effect of referring service on the usefulness of a muscle biopsy.…”

Section: Introductionmentioning

confidence: 99%

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Referring Service Effect on Muscle Biopsy Diagnosis and Management in Myopathy

Tenny¹,

Schmidt²,

Follett³

2018

Cureus

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IntroductionRequests for muscle biopsy for evaluation of myopathy originate from a variety of different specialties. It is unknown whether the specialty of the referring service affects the likelihood of diagnostic biopsy or the therapeutic usefulness of a biopsy.MethodsWe reviewed 106 consecutive muscle biopsies requested by healthcare providers in neurology, rheumatology, family medicine, oncology, and gastroenterology. We tested for an association between referring service and whether the biopsy yielded a definitive pathology result or provided therapeutically useful results.ResultsHalf of the biopsies (49%) returned definitive pathology and 88% of the biopsies provided information that contributed to therapeutic decisions. The diagnostic yield for muscle biopsies referred by different services was not statistically significant (p-value 0.1344) nor was the therapeutic yield statistically significant for muscle biopsies referred by different services (p-value 0.5525).DiscussionThe specialty of the service that requests a muscle biopsy does not influence the likelihood of obtaining a definitive pathological diagnosis or therapeutically useful information. Other factors may be more important in determining the likelihood of obtaining a clinically useful biopsy result.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Referring Service Effect on Muscle Biopsy Diagnosis and Management in Myopathy

Tenny¹,

Schmidt²,

Follett³

2018

Cureus

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Nerve and skin biopsy in neuropathies

Sommer¹

2018

Current Opinion in Neurology

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Nerve biopsy is still the gold standard for the diagnosis of peripheral nerve vasculitis. In other indications, sural or superficial peroneal nerve biopsies are less frequently done, because less invasive methods have become available. Modern imaging methods allow localization of nerve damage, such that targeted fascicular biopsies can be done. Immunofluorescence staining of teased nerve fibers has contributed to the understanding of the pathophysiology of inflammatory neuropathies. Skin biopsy has become a routine method to diagnose small fiber neuropathy.

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An assessment of preoperative evaluation modalities in predicting muscle biopsy diagnostic yield and therapeutic impact

So¹,

Kp²,

Br³

et al. 2018

Rheumatol Orthop Med

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Background/Objectives: Muscle biopsies are requested for the workup of myopathy when less invasive workup is inconclusive. We set forth to build a multivariate model of preoperative testing to increase the odds of diagnostic and therapeutic yield of a muslce biopsy. Methods:A 5-year retrospective chart review of 106 patients who underwent muscle biopsy was performed to evaluate preoperative workup including: magnetic resonance imaging, electromyography, muscle strength testing and laboratory evaluation including creatine kinase level, lactate level, urine myoglobin, acetylcholinesterase antibody testing, genetic testing or use of steroids in the preoperative period using Student's two-tailed t-test, two-tailed Fisher's exact test and multivariate regression model. Results:We found an overall biopsy diagnostic pathologic yield of 47% and therapeutic yield of 88%. None of the variables reached a level of significance of p-value < 0.05 in univariate testing. In the multivariate model preoperative use of steroids and creatine kinase were the closest predictors of diagnostic and therapeutic yield but failed to reach statistical significance. Conclusions:The therapeutic impact of muscle biopsies appears to be much greater than the diagnostic pathologic yield and the therapeutic impact larger than previously reported when rigorously defined. We were unable to create a statistically significant preoperative predictive model for muscle biopsy diagnostic and therapeutic yield.

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Evaluation of simultaneous muscle and nerve biopsies for the diagnosis of neuromuscular diseases

Cited by 4 publications

References 10 publications

Referring Service Effect on Muscle Biopsy Diagnosis and Management in Myopathy

Referring Service Effect on Muscle Biopsy Diagnosis and Management in Myopathy

Nerve and skin biopsy in neuropathies

An assessment of preoperative evaluation modalities in predicting muscle biopsy diagnostic yield and therapeutic impact

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