A Continuum of Nerve Biopsies in Peripheral Neuropathy: A Clinicopathological Insight

Background: Peripheral neuropathy is a common neurological disease faced by the neurologists these days. The role of nerve biopsy is ambiguous and the dilemma to identify the underling etiology further adds to the uncertainty. However, ruling out certain etiological causes and confirming specific diagnosis still mandates the procedure. Aim: The aim of the study is to evaluate the contribution of nerve biopsy in peripheral neuropathies and study the histomorphological spectrum of these biopsies. Material and methods: A retrospective 2-year review of 54 nerve biopsies received in the Department of Pathology was performed at a tertiary care centre. Results: A total of 54 nerve biopsies were reviewed during the study period, of which, 6 biopsies (11%) were considered inadequate. Biopsies were broadly divided as biopsies supportive for patient management and biopsies essential for patient management. Biopsies essential for patient management (n=16) comprise vasculitic neuropathy (n=9), lepromatous neuropathy (n=4), hereditary motor sensory neuropathy (n=1) and CIDP (n=2). Biopsies supportive for patient management (n=14) comprise axonal neuropathies (n=6), demyelinating neuropathies (n=5) and mixed neuropathies (predominantly Axonal with secondary demyelinating features, n=3). No diagnostic pathology was identified in 13 cases (24%). Conclusion: With the advent of molecular tests and electrophysiologic examinations, nerve biopsy is losing its charm. However, its contribution still hold grounds in specific etiologies like Vasculitic neuropathy, lepromatous neuropathy and to some extent in management of CIDP. Increase in awareness among the pathologists of the histomorphology is essential to aid the physicians managing these patients.