Podcast
Questions and Answers
When should nerve biopsy be considered for diagnosing CIDP?
When should nerve biopsy be considered for diagnosing CIDP?
- Only when there is little or no response to treatment
- Both B and C (correct)
- As a routine procedure
- Only when other diagnostic methods cannot confirm CIDP
What should be observed when performing nerve biopsy?
What should be observed when performing nerve biopsy?
- Maximal standards for processing and evaluating nerve biopsies
- Minimal standards for processing and evaluating nerve biopsies (correct)
- No specific standards for processing and evaluating nerve biopsies
- Only the patient's consent
Which nerve is most commonly biopsied for CIDP diagnosis?
Which nerve is most commonly biopsied for CIDP diagnosis?
- Sural nerve (correct)
- Peroneal nerve
- Median nerve
- Radial nerve
What are some findings suggestive of CIDP on nerve biopsy?
What are some findings suggestive of CIDP on nerve biopsy?
What is the success rate of immunomodulating agents in patients diagnosed with CIDP through biopsy?
What is the success rate of immunomodulating agents in patients diagnosed with CIDP through biopsy?
What are the limitations of nerve biopsies in CIDP diagnosis?
What are the limitations of nerve biopsies in CIDP diagnosis?
What type of testing is strongly advised in adult patients with a clinical suspicion of CIDP?
What type of testing is strongly advised in adult patients with a clinical suspicion of CIDP?
What should be included in monoclonal gammopathy testing for CIDP diagnosis?
What should be included in monoclonal gammopathy testing for CIDP diagnosis?
What should be done if a gammopathy is found during monoclonal gammopathy testing for CIDP diagnosis?
What should be done if a gammopathy is found during monoclonal gammopathy testing for CIDP diagnosis?
What should be considered in patients with distal CIDP regarding monoclonal gammopathy testing?
What should be considered in patients with distal CIDP regarding monoclonal gammopathy testing?
When is VEGF serum level testing indicated in patients with a distal and painful CIDP phenotype?
When is VEGF serum level testing indicated in patients with a distal and painful CIDP phenotype?
What are some complications associated with sural nerve biopsy?
What are some complications associated with sural nerve biopsy?
When should nerve biopsy be performed to diagnose CIDP?
When should nerve biopsy be performed to diagnose CIDP?
Who should be available to perform nerve biopsies?
Who should be available to perform nerve biopsies?
What should patients be informed of before undergoing nerve biopsy?
What should patients be informed of before undergoing nerve biopsy?
What type of nerve biopsy is more likely to provide useful information?
What type of nerve biopsy is more likely to provide useful information?
What are some findings suggestive of CIDP on nerve biopsy?
What are some findings suggestive of CIDP on nerve biopsy?
What is the purpose of the statement on nerve biopsy?
What is the purpose of the statement on nerve biopsy?
What is strongly advised in adult patients with a clinical suspicion of CIDP?
What is strongly advised in adult patients with a clinical suspicion of CIDP?
What tests should be included when testing for serum monoclonal proteins?
What tests should be included when testing for serum monoclonal proteins?
What should be done if a gammopathy is found during monoclonal gammopathy testing?
What should be done if a gammopathy is found during monoclonal gammopathy testing?
What is the potential complication associated with sural nerve biopsy?
What is the potential complication associated with sural nerve biopsy?
What is the success rate of treating patients with immunomodulating agents after a biopsy-guided diagnosis of CIDP?
What is the success rate of treating patients with immunomodulating agents after a biopsy-guided diagnosis of CIDP?
What is the accuracy of nerve biopsy?
What is the accuracy of nerve biopsy?
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Study Notes
Good Practice Points for Nerve Biopsy and Monoclonal Gammopathy Testing in CIDP Diagnosis
Nerve Biopsy:
- Nerve biopsy should not be performed routinely to diagnose CIDP.
- It should only be considered in specific circumstances, such as when CIDP cannot be confirmed by other tests or when alternative diagnoses are being considered.
- Skilled surgeons, neuropathologists, and specialized pathology laboratory facilities should be available to perform nerve biopsies.
- The accuracy of nerve biopsy is limited, and patients should be informed of this before undergoing the procedure.
- Minimal standards for processing and evaluating nerve biopsies should be followed.
- Biopsy of a clinically affected nerve is more likely to provide useful information.
- Findings suggestive of CIDP on nerve biopsy may include thinly myelinated axons, small onion bulbs, perivascular macrophage clusters, and demyelination on electron microscopy.
- Clinical outcomes in patients with suspected CIDP who are treated with immunomodulating agents after a biopsy-guided diagnosis of CIDP have been successful.
- Nerve biopsy may reveal findings suggestive of a different or differential diagnosis, leading to appropriate therapy.
- Sural nerve biopsy is associated with numbness in the area of innervation and other potential complications.
- The statement on nerve biopsy is intended to reduce the number of unnecessary biopsies for suspected CIDP.
Monoclonal Gammopathy Testing:
- Testing for serum monoclonal proteins is strongly advised in adult patients with a clinical suspicion of CIDP.
- Testing should include serum protein electrophoresis and immunofixation, spot urine immunofixation for light chains, and measurement of serum free light chains.
- If a gammopathy is found, further evaluation may be required, and haematology-oncology consultation should be strongly considered.
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