Peripheral nerve biopsies

Nerve biopsies require special handling procedures thai may not be familiar to many surgical pathologists. Most pathology laboratories handle fewer than 10 nerve biopsies per year, often referring them to specialized laboratories for evaluation. However, initial handling procedures may affect the ability of the reference laboratory to evaluate the specimen, and the remote location may impede communications and increase the time required for diagnostic evaluation. In a recent needs assessment questionnaire conducted by the College of American Pathologists, a need for understanding the handling of peripheral nerve biopsies was identified. Reference laboratories reported that clinical history and electrophysiologic data are very helpful, both in planning the handling of the biopsy and in interpreting the findings. Understanding the clinical differential diagnosis and the relationships between the differential diagnosis and the use of specialized studies often helps in the initial handling of peripheral nerve biopsies, whether evaluated locally or referred to a specialized laboratory. In this paper, we offer some general guidelines for handling nerve biopsies, including the rationale for the studies commonly used to evaluate them. With this background, decisions may be made about handling specimens that are specific for the clinical situation and allow for the highest diagnostic yield and fastest turnaround times.