A previous evaluation of concomitant nerve and muscle biopsy in the Centre for Neuromuscular Diseases, NHNN suggested that the addition of muscle (vastus lateralis) to nerve (sural) tissue examination did not improve diagnostic yield in suspected vasculitis. Here we assess it may be beneficial in other circumstances.
We reviewed diagnostic yield from combined nerve and muscle biopsies performed between 2013 and 2018. Basic demographic, clinical and histological information was collected retrospectively from the complete list of locally performed biopsies during the study period.
230 nerve and 49 muscle biopsies were performed on 223 patients. 26 superficial peroneal/peroneus brevis, 20 sural/vastus lateralis, and 3 other combinations. Overall nerve biopsy was diagnostic in 38% of individuals; confirming clinical suspicion in 64.5%. The addition of muscle tissue did not provide histological evidence of vasculitic pathology in any case. However, 8 cases provided evidence of co-existent muscle pathology (myopathic changes), with mitochondrial changes in 4/8 and lipid abnormalities in 2/8 informing further genetic tests and leading to diagnosis in 3/8. 5/5 TTR amyloidosis and 2/3 neurolymphomatosis cases showed histopathology in both tissues.
This analysis suggests that in certain clinical situations the addition of muscle biopsy may be helpful in the investigation of neuropathy.
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