Original Research ARTICLE
Diagnostic value of sural nerve biopsy: retrospective analysis of clinical cases from 1981 to 2017
- 1University of Genoa, Italy
- 2Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Science, School of Medical and Pharmaceutical Sciences, University of Genoa, Italy
- 3Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Science, School of Medical and Pharmaceutical Sciences, University of Genoa, Italy
- 4Department of Integrated Surgical and Diagnostic Sciences, School of Medical and Pharmaceutical Sciences, University of Genoa, Italy
- 5San Martino Hospital (IRCCS), Italy
Nerve biopsy represents the conclusive step in the diagnostic work-up of peripheral neuropathies, and its diagnostic yield is still debated. The aim of this study is to consider the impact of nerve biopsy on reaching a useful diagnosis in different peripheral neuropathies and its changing over time.
We retrospectively analyzed 1179 sural nerve biopsies performed in the period 1981-2017 at Neurological Clinic of Policlinico San Martino (Genoa). We relied on medical records and collected both clinical and pathological data in a database.
Biopsy provided univocal diagnoses in 53% of cases (with an increase over time), multiple diagnostic options in 14%, while diagnosis was undetermined in 33% (undetermined reports decreased during the years). In 57% of patients, the pre-biopsy suspicion was confirmed, while in 43% sural biopsy modified the clinical diagnosis. The highest yield was in axonal neuropathies (29% undetermined reports versus 40% in demyelinating and 48% in mixed neuropathies). In 68% of patients with vasculitic neuropathy, this etiology was already suspected, whereas in 32% nerve biopsy modified the clinical diagnosis. During the years, the number of annually performed biopsies decreased significantly (p=0.007), with an increase in the mean age of patients (p<0.0001). The percentage of hereditary neuropathies had a significant decrease (p=0.016), while the rate of vasculitic and chronic inflammatory neuropathies increased (p<0.0001).
This is the largest Italian study addressing the yield of sural nerve biopsy. During the years, we observed a progressive refinement of the indication of this procedure, which confirms its utility for interstitial neuropathies, particularly if non-systemic vasculitic neuropathy is suspected.
Keywords: amyloidotic neuropathy, Neuropathy, axonal neuropathies, Demyelinating neuropathies, Vasculitic neuropathy, Sural nerve biopsy
Received: 01 Aug 2019;
Accepted: 01 Nov 2019.
Copyright: © 2019 Prada, Massucco, Venturi, Geroldi, Bellone, Mandich, Minuto, VARALDO, Mancardi, Grandis and Schenone. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: PhD. Valeria Prada, University of Genoa, Genoa, Italy, email@example.com