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أعرض في EDS

Sural nerve biopsy utility by masked assessment of individual histologic preparations.

التفاصيل البيبلوغرافية
العنوان: Sural nerve biopsy utility by masked assessment of individual histologic preparations.
المؤلفون: Soontrapa P; Department of Neurology, Mayo Clinic Foundation, Rochester, Minnesota, USA., Dyck PJ; Department of Neurology, Mayo Clinic Foundation, Rochester, Minnesota, USA., Dyck PJB; Department of Neurology, Mayo Clinic Foundation, Rochester, Minnesota, USA., Klein CM; Department of Neurology, University of North Carolina, Chapel Hill, North Carolina, USA., Engelstad J; Department of Neurology, Mayo Clinic Foundation, Rochester, Minnesota, USA., Davies J; Department of Neurology, Mayo Clinic Foundation, Rochester, Minnesota, USA., Shahar S; Department of Neurology, Mayo Clinic Foundation, Rochester, Minnesota, USA.; Department of Neurology, Rambam Health Care Campus, Haifa, Israel.; Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel., Harmsen WS; Quantitative Health Sciences, Department of Neurology, Mayo Clinic Foundation, Rochester, Minnesota, USA., Mandrekar J; Quantitative Health Sciences, Department of Neurology, Mayo Clinic Foundation, Rochester, Minnesota, USA., Spinner RJ; Department of Neurosurgery, Mayo Clinic Foundation, Rochester, Minnesota, USA., Ida CM; Department of Laboratory Medicine and Pathology, Mayo Clinic Foundation, Rochester, Minnesota, USA., Klein CJ; Department of Neurology, Mayo Clinic Foundation, Rochester, Minnesota, USA.; Department of Laboratory Medicine and Pathology, Mayo Clinic Foundation, Rochester, Minnesota, USA.
المصدر: Journal of the peripheral nervous system : JPNS [J Peripher Nerv Syst] 2023 Jun; Vol. 28 (2), pp. 191-201. Date of Electronic Publication: 2023 Apr 20.
نوع المنشور: Case Reports; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: Wiley Country of Publication: United States NLM ID: 9704532 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1529-8027 (Electronic) Linking ISSN: 10859489 NLM ISO Abbreviation: J Peripher Nerv Syst Subsets: MEDLINE
أسماء مطبوعة: Publication: <2010->: Hoboken, NJ Wiley
Original Publication: New York, NY : Woodland Publications, c1996-
مواضيع طبية MeSH: Sural Nerve*/pathology , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating*/diagnosis, Adult ; Humans ; Paraffin ; Reproducibility of Results ; Biopsy/methods
مستخلص: Background and Aims: Comprehensive study of sural nerve biopsy utility based on individual histopathologic preparations is lacking. We aimed to quantify the value of different histologic preparations in diagnosis.
Methods: One hundred consecutive sural nerves were studied by standard histological preparations plus graded teased nerve fibers (GTNF), immunohistochemistry, and epoxy-semithin morphometry. Three examiners scored the individual preparations separately by a questionnaire of neuropathic and interstitial abnormalities, masked to the biopsy number, versus a gold-standard of all preparations. Multivariate modeling was utilized to determine best approach versus the gold-standard.
Results: Highest confidence (range 8-9 of 10) and inter-rater reliability (99%) for fiber abnormalities came from GTNF, and interstitial abnormalities from paraffin stains (range 7-8, 99%). Vasculitic neuropathy associated with GTNF axonal degeneration (moderate to severe 79%) with OR 3.8, 95% CI (1.001-14.7), p = .04, but not significantly with the other preparations. Clinicopathologic diagnoses associated with teased fiber abnormalities in chronic inflammatory demyelinating polyradiculoneuropathy, 80% (8/10); amyloidosis, 50% (1/2); adult-onset polyglucosan disease 100% (1/1). GTNF and paraffin stains significantly correlated with fiber density determined by morphometric analysis (GTNF: OR 9.9, p < .0001, paraffin: OR 3.8, p = .03). GTNF combined with paraffin sections had highest accuracy for clinicopathologic diagnoses and fiber density with 0.86 C-stat prediction versus morphometric analysis. Pathological results lead to initiation or changes of immunotherapy in 70% (35/50; initiation n = 22, reduction n = 9, escalation n = 4) with the remaining having alternative intervention or no change.
Interpretation: Nerve biopsy paraffin stains combined with GTNF have highest diagnostic utility, confidence, inter-rater reliability, improving accuracy for a pathologic diagnosis aiding treatment recommendations. Immunostains and epoxy preparations are also demonstrated useful supporting consensus guidelines. This study provides class II evidence for individual nerve preparation utility.
(© 2023 Peripheral Nerve Society.)
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فهرسة مساهمة: Keywords: biopsy; histopathology; immunostains; neuropathy; teased fibers
المشرفين على المادة: 8002-74-2 (Paraffin)
تواريخ الأحداث: Date Created: 20230405 Date Completed: 20230608 Latest Revision: 20230620
رمز التحديث: 20240829
DOI: 10.1111/jns.12545
PMID: 37017656
قاعدة البيانات: MEDLINE
الوصف
تدمد:1529-8027
DOI:10.1111/jns.12545