Method Reports of sural nerve biopsies, done between period of January 2000 and March 2010 at Neuropathology Department of Frenchay Hospital were analysed retrospectively.

Results The total number of biopsies was 194. 111 were from males and 83 from females. The age range was 2–85 years, mean 62 years). Peripheral neuropathy was diagnosed in 144 (74%) cases. No diagnosis could be made in 50 cases (26%), 21 (11%) biopsies showed normal peripheral nerve tissue and 28 (15%) showed only mild, non-specific changes (eg, Renaut bodies). In 98 (50%), peripheral neuropathy was diagnosed but without specific abnormalities to indicate the aetiology. A specific aetiology was established in only 46 cases (23%). Axonal neuropathy by far the commonest type of neuropathy 121 (62%) but in only 36 cases (18%) was a specific underlying cause identified. Vasculitis was the commonest identified cause of axonal neuropathy, in 28 (14%) cases. Demyelinating neuropathy was present in only 12 biopsies (6%) and a cause identified in 3 (1%); two biopsies showed changes of CIDP. Other, miscellaneous diagnoses, in 8 (4%) of biopsies, included neurofibroma, amyloidosis and infiltration by chronic lymphocytic leukaemia cells.

Conclusion Sural nerve biopsy is a well established diagnostic procedure for the investigation of peripheral neuropathy but our study shows it has a limited specific aetiological diagnostic yield. We recommend sural nerve biopsy should be considered only in well selected patient groups.