Nerve biopsy: indications and contribution to the diagnosis of peripheral neuropathy. The experience of the Born Bunge Foundation University of Antwerp and University of Liege between 1987 and 1997.
Biopsy/methods; Hereditary Motor and Sensory Neuropathies/diagnosis/pathology; Humans; Nerve Tissue/pathology; Peripheral Nervous System Diseases/diagnosis/pathology; Polyneuropathies/diagnosis/pathology
Abstract :
[en] We reviewed 355 nerve biopsies analysed at the Laboratories of Neuropathology of the Born-Bunge Foundation/University of Antwerp (BBF/UIA) and University of Liege (ULg) between 1987 and 1997. We examined the indications for nerve biopsy, the yield of the procedure, and the influence of clinical and neuropathological parameters. Contributory biopsies accounted for 35.5% and 47.3% respectively at ULg and BBF/UIA laboratories: of these, one third showed specific histological findings, the majority being informative only when combined with the relevant clinical data. The profile of indications for nerve biopsy was roughly comparable in both laboratories. The search for an inflammatory neuropathy prompted 35-40% of all biopsies with more than 50% of specimens being informative in this indication. The lowest yield (20%) was obtained among the nerve biopsies performed in the absence of any presumptive aetiology. These accounted for 22-33% of all cases. Inadequate surgical resection, delays in transport or processing errors precluded histological study of 4% (BBF/UIA) to 8% (ULg) of the specimens. We conclude that nerve biopsies should be performed by experienced surgeons and handled in specialised laboratories. Only a relatively small number of causes of neuropathy can be diagnosed on the basis of histology alone. More often, contributory biopsies will result from the combination of non-specific suggestive histological features with relevant clinical information. The diagnostic yield of nerve biopsy is function of careful patient selection and close collaboration between the clinician and the neuropathologist.
Disciplines :
Neurology
Author, co-author :
Deprez, Manuel ; Université de Liège - ULiège > Département des sciences biomédicales et précliniques > Anatomie et cytologie pathologiques
Ceuterick-de Groote, C.; Born-Bunge Foundation University of Antwerp > Laboratory of Neuropathology
Schoenen, Jean ; Centre Hospitalier Universitaire de Liège - CHU > Neurologie CHR
Reznik, Michel ; Université de Liège - ULiège > Services généraux (Faculté de médecine) > Relations académiques et scientifiques (Médecine)
Martin, J. J.; Born-Bunge Foundation University of Antwerp > Laboratory of Neuropathology
Language :
English
Title :
Nerve biopsy: indications and contribution to the diagnosis of peripheral neuropathy. The experience of the Born Bunge Foundation University of Antwerp and University of Liege between 1987 and 1997.
ARGOV Z., SOFFER D., STEINER I. The yield of sural nerve biopsy in the evaluation of peripheral neuropathies. Acta Neurol. Scand. 1989, 79 : 243-5.
ASBURY A. K., GILLIAT R. W. The clinical approach to neuropathy. In : Peripheral Nerve disorders. A practical approach. ASBURY A. K., GILLIAT R. W. (eds.). London, Butterworths, 1984, 1-20.
AZULAY J. P., POUGET J., PELLISSIER J. F., BLIN O., SERRATRICE G. [Chronic polyradiculoneuritis. 25 cases]. Rev. Neurol. (Paris), 1992, 148 : 752-61.
BAROHN R. J., KISSEL J. T., WARMOLTS J. F. Chronic inflammatory polyradiculoneuropathy. Clinical characteristics, course, and recommendations for diagnostic criteria. Arch. Neurol., 1989, 46 : 878-84.
BOUCHE P., BRUNET P., VALLAT J. M Orientation diagnostique. Epidémiologie. In : Neuropathies périphériques. BOUCHE P., VALLAT J. M. (eds.). Paris, Masson, 1992, 32-6.
BOUCHE P., MAISONOBE T., LE FORESTIER N. Conduite à tenir devant une polyneuropathie. Rev. Neurol. (Paris), 1998, 154 : 552-6.
CEUTERICK-DE GROOTE C., MARTIN J. J. Extracerebral biopsy in lysosomal and peroxisomal disorders. Ultrastructural findings. Brain. Pathol., 1998, 1 : 121-32.
CHIA L., FERNANDEZ A., LACROIX C., ADAMS D., PLANTE V. et al.. Contribution of nerve biopsy findings to the diagnosis of disabling neuropathy in the elderly. A retrospective review of 100 consecutive patients. Brain, 1996, 19: 1091-8.
CORVOISIER N., VALLAT J. M., HUGON J. Les neuropathies de cause indéterminée. Etude de 48 cas. Rev. Neurol. (Paris), 1987, 143 : 279-83.
DEPREZ M., CEUTERICK-DE GROOTE C. , GOLLOGLY L., REZNIK M., MARTIN J. J. Clinical and neuropathological parameters affecting the diagnostic yield of nerve biopsy. Neuromuscul. Disord., 2000, 10 : 92-8.
DYCK P. J., OVIATT K. F., LAMBERT E. H. Intensive evaluation of referred unclassified neuropathies yields improved diagnosis. Ann. Neurol, 1981, 10 : 222-6.
DYCK P. J., BENSTEAD T. J., CONN D. L., STEVENS J. C., WINDEBANK A. J., Low P. A. Nonsystemic vasculitic neuropathy. Brain, 1987, 110 : 843-53.
DYCK P. J., DYCK J. B., CHALK C. H. The 10 P's : a mnemonic helpful in characterization and differential diagnosis of peripheral neuropathy. Neurology, 1992, 42 : 14-8.
DYCK P. J., GIANNINI C., LAIS A. Pathological alterations of nerve. In : Peripheral Neuropathy. DYCK P. J., THOMAS P. K. (eds.). Philadelphia, Saunders, 1993, 514-97.
DYCK P. J., DYCK P. J. D., GRANT I. A., FEALEY R. D. Ten Steps in Characterising and Diagnosing Patients with Peripheral Neuropathy. Neurology, 1996, 47 : 10-7.
GABREELS-FESTEN A., GABREELS F. J. M., HOOGENDIJK D. A., BOLHUIS P. A., JONGEN P. J. H., VINGER-HOETS H. M. Chronic inflammatory demyelinating polyneuropathy or hereditary motor and sensory neuropathy ? Diagnostic value of morphological criteria. Acta Neuropathol., 1993, 86 : 630-5.
GRAHAM F., WINTERHOLLER M., NEUNDORFER B. Cryptogenic polyneuropathies : an out-patient follow-up study. Acta Neurol. Scand., 1991, 84 : 221-5.
HARATI Y., NIAKAN E. The clinical spectrum of inflammatory-angiopathic neuropathy. J. Neurol. Neurosurg. Psychiatry, 1986, 49 : 1313-6.
HAWKE S. H., DAVIES L., PAMPHLETT R., GUO Y. D., POLLARD J. D., MCLEOD J. G. Vasculitic neuropathy. A clinical and pathological study. Brain, 1991, 114: 2175-90.
HESSEL L., CORVOISIER N., VALLAT J. M., MICHEL J. P. Etiologies des neuropathies périphériques chez les personnes agées. Médecine Hygiène, 1986, 44 : 1354-60.
KISSEL J. T., MENDELL J. R. Vasculitic neuropathy. Neurol. Clinics, 1992, 10 : 761-81.
KRENDEL D. A., PARKS H. P., ANTHONY C., ST CLAIR M. B., GRAHAM D. G. Sural nerve biopsy in chronic inflammatory demyelinating polyradiculoneuropathy. Muscle Nerve, 1989, 12 : 257-64.
KURTZKE J. F. The current neurological burden of illness in the United States. Neurology 1982, 32 : 1207-14.
MARTIN J. J. Hereditary disorders of the nervous system. From anatomo-clinical studies to molecular biology. Acta Neurol. Belg., 1996, 96 : 240-6.
MATTHEWS W. B. Cryptogenic polyneuritis. Proc. R. Soc. Med., 1952, 45 : 667-9.
MCCARTHY B. G., HSIEH S. T., STOCKS A., HAUER P., MACKO C., COMBLATH D. R., GRIFFIN J. W., MCARTHUR J. C. Cutaneous innervation in sensory neuropathies : evaluation by skin biopsy. Neurology, 1995, 45 : 1848-55.
MCLEOD J. G., POLLARD J. D., CAMERON J., WALSH J. C. Chronic polyneuropathy of undetermined cause. J. Neurol Neurosurg. Psychiatry, 1984, 47 : 530-5.
MIDRONI G., BILBAO J. M. Examination of the Peripheral Nerve Biopsy. In : Biopsy diagnosis in peripheral neuropathy. MIDRONI G., BILBAO J. M. (eds.). Newark, Butterworths, 1995a, 120-3.
MIDRONI G., BILBAO J. M. Examination of the Peripheral Nerve Biopsy. In : Biopsy diagnosis in peripheral neuropathy. MIDRONI G., BILBAO J. M. (eds.). Newark, Butterworths, 1995b, 1-11.
MIDRONI G., BILBAO J. M. Examination of the Peripheral Nerve Biopsy. In : Biopsy diagnosis in peripheral neuropathy. MIDRONI G., BILBAO J. M. (eds.). Newark, Butterworths, 1995c, 241-62.
MOLENAAR D. S., VERMEULEN M., DE HAAN R. Diagnostic value of sural nerve biopsy in chronic inflammatory demyelinating polyneuropathy. J. Neurol. Neurosurg Psychiatry, 1998, 64 : 84-9.
NEUNDORFER B., GRAHAM F., ENGELHARDT A., HARTE U. Postoperative effects and value of sural nerve biopsies : a retrospective study. Eur. Neurol., 1990, 30 : 350-2.
NOTERMANS N. C., WOKKE J. H. J., FRANSSEN H., VAN DER GRAAF Y., VERMEULEN M. et al. Chronic idiopathic polyneuropathy presenting in middle or old age. J. Neurol. Neurosurg. Psychiatry, 1993, 56 : 1066-71.
OH S. J. Diagnostic usefulness and limitations of the sural nerve biopsy. Yonsei Med J., 1990, 31 : 1-26.
RAPPAPORT W. D., VALENTE J., HUNTER G. C., RANGE N. E., LICK S. et al.. Clinical utilization and complications of sural nerve biopsy. Am. J. Surg., 1993, 166 : 252-6.
SAID G., LACROIX-CIAUDO C., FUJIMURA H., BLAS C., FAUX N. The peripheral neuropathy of necrotizing arteritis. A clinico-pathological study. Ann. Neurol., 1988, 23: 461-5.
SCHRODER J. M. Recommandations for the examination of peripheral nerve biopsies. Virchows Archive 1998, 432 : 199-205.
SERRATRICE G., PELLISSIER J.F., POUGET J. Neuropathies inflammatoires et dysimmunes. In : Les maladies neuromusculaires. SERRATRICE G., PELLISSIER J. F., POUGET J. (eds.). Paris, Masson, 1994, 178-88.
SMALL G. A., LOVELACE R. E. Chronic Inflammatory Demyelinating Polyneuropathy. Semin. Neurol., 1994, 30 : 305-12.
THE ITALIAN GENERAL PRACTITIONER STUDY GROUP (IGPSG). Chronic symmetric symptomatic polyneuropathy in the elderly : A field screening investigation of two Italian regions. I. Prevalence and general characteristics of the sample. Neurology, 1995, 45 : 1832-6.
VALLAT J. M., CORVOISIER N., DUMAS M. Analysis of 380 cases of peripheral neuropathy seen in a general hospital. In : Peripheral Neuropathy, Proceedings of the International Symposium on Peripheral Neuropathy. SOBUE I. (ed.). Amsterdam, Excerpta Medica, 1983, 111-3.
VINCENT D., DUBAS F., HAUS J. J. Microvasculites nerveuses et musculaires : 50 cas. Rev. Neurol., 1985, 141 : 440-6.