an old paper re sural nerve bx in diagnosis

    • Anonymous
      March 29, 2010 at 11:11 am

      [I]so I guess I’m not surprised that my neuro guru rather graphically explained the procedure to me before suggesting we let the EMG doc have at me first. He felt the physical exam, blood work, lumbar puncture and thorough EMGs would give him/me all the info we needed … and it did.[/I]

      Department of Neurology, Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam
      Dr DSM Molenaar, Department of Neurology (H2–214), Academic Medical Center, PO Box 22700, 1100 DE Amsterdam, The Netherlands. Telephone 0031 20 5663546; fax 0031 20 6971438; emailD.MOLENAAR@AMC.UVA.NL

      OBJECTIVE To investigate the additional diagnostic value of sural nerve biopsy of 64 patients in whom chronic inflammatory demyelinating polyneuropathy (CIDP) was considered, as sural nerve biopsy is recommended in the research criteria of an ad hoc subcommittee to diagnose CIDP.

      METHODS Firstly, the additional diagnostic value of sural nerve biopsy was analysed with multivariate logistic re- gression. Six clinical features (remitting course, symmetric sensorimotor neuropathy in arms and legs, areflexia, raised CSF protein concentration, nerve conduction studies consistent with demyelination, and absence of comorbidity or relevant laboratory abnormalities) were entered into a logistic model. Afterwards, all significant features identified from this model, as well as the results of sural nerve biopsy were forced into a second logistic model. Secondly, the diagnostic performance of a neurologist experienced in diagnosis of peripheral nerve disorders was studied by receiver operating characteristics (ROC) curve analysis.

      RESULTS The results of the first logistic analysis showed that CSF protein concentration >1 g/l (odds ratio (OR)=38.5) and neurophysiological studies consistent with demyelination (OR=51.7) were strong predictors of CIDP. When forcing the significant features and the sural nerve biopsy data into the model, an independent predictive value of sural nerve biopsy could not be found. The neurologist was able to discriminate patients with and without CIDP (area under the curve (AUC)=0.95). His diagnostic performance did not improve significantly by offering him the results of sural nerve biopsy.

      CONCLUSION Any additional diagnostic value of sural nerve biopsy in the diagnosis of CIDP could not be shown.

    • March 29, 2010 at 11:49 am

      I think people who do not have conclusive ncv/emg or absent protein elevations are the people who turn to the biopsy.

    • Anonymous
      March 29, 2010 at 8:18 pm

      And then? Only if the biopsy sample is handled with the utmost care and tested by the best labs available! Four/five years ago I looked into it as one neuro felt it MUST be done? Well, turned out more ‘samples’ were improperly handled than properly [by whatever standards the med. community had established] And, that many insurance companies were hesitant to cover this testing because of potential and often serious infections at the biopsy site- testing that yielded less than optimal results thru other convential testings.. The blood work, spinal work, MRI’s [to assure no other nerve impingement], the varied nerve conduction studies etc are much less invasive than the SURAL BIOPSY! The one doc who suggested it to me? I went NO WAY! Got all the other tests in and 7 out of 12 is pretty good! The risk is too great. -Not to mention? I felt this particular, somewhat new neuro wanted to ‘do one’ to get it on his resume’? He referred me to his mentor a neuro dept head at a local teaching hospital? Who went into our visit w/ a MUST DO BIOPSY attitude? But after I was done? He sent me a letter that stated NO, didn’t need to be done, That I was WELL ‘informed’ [thank you folks here? and elsewhere] and that I did NOT need a biopsy. Whew!
      Now, if all tests were marginal? Then I mite consider it? But Truly if most test results say it’s a DUCK? It’s not likely to be a swan, ya know? Or, maybe new/more tests need to be done. There, enuf… but knowing is to know and learn more about the whole thing…. See if you can get into your ins. co’s web site and see what their policies are? Sometimes you can, other times not..Used to be easy, not so now. Good luck!!!!!!!!!!!

    • Anonymous
      May 18, 2010 at 12:19 pm

      [QUOTE=Dawn Kevies mom]I think people who do not have conclusive ncv/emg or absent protein elevations are the people who turn to the biopsy.[/QUOTE]

      Exactly. That would be folks such as myself. Inconclusive, or negative results on every test ‘they’ ever ran. Dozens and dozens of tests by dozens of doctors.

      However, in my case, a sural nerve biopsy likely would have been negative.