Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1998 Jan;64(1):84–89. doi: 10.1136/jnnp.64.1.84

Diagnostic value of sural nerve biopsy in chronic inflammatory demyelinating polyneuropathy

D Molenaar 1, M Vermeulen 1, R de Haan 1
PMCID: PMC2169919  PMID: 9436733

Abstract

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.



Full Text

The Full Text of this article is available as a PDF (159.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Albers J. W., Kelly J. J., Jr Acquired inflammatory demyelinating polyneuropathies: clinical and electrodiagnostic features. Muscle Nerve. 1989 Jun;12(6):435–451. doi: 10.1002/mus.880120602. [DOI] [PubMed] [Google Scholar]
  2. Argov Z., Steiner I., Soffer D. The yield of sural nerve biopsy in the evaluation of peripheral neuropathies. Acta Neurol Scand. 1989 Mar;79(3):243–245. doi: 10.1111/j.1600-0404.1989.tb03745.x. [DOI] [PubMed] [Google Scholar]
  3. Barohn R. J., Kissel J. T., Warmolts J. R., Mendell J. R. Chronic inflammatory demyelinating polyradiculoneuropathy. Clinical characteristics, course, and recommendations for diagnostic criteria. Arch Neurol. 1989 Aug;46(8):878–884. doi: 10.1001/archneur.1989.00520440064022. [DOI] [PubMed] [Google Scholar]
  4. Dyck P. J., Lais A. C., Ohta M., Bastron J. A., Okazaki H., Groover R. V. Chronic inflammatory polyradiculoneuropathy. Mayo Clin Proc. 1975 Nov;50(11):621–637. [PubMed] [Google Scholar]
  5. Krendel D. A., Parks H. P., Anthony D. C., St Clair M. B., Graham D. G. Sural nerve biopsy in chronic inflammatory demyelinating polyradiculoneuropathy. Muscle Nerve. 1989 Apr;12(4):257–264. doi: 10.1002/mus.880120402. [DOI] [PubMed] [Google Scholar]
  6. McCombe P. A., Pollard J. D., McLeod J. G. Chronic inflammatory demyelinating polyradiculoneuropathy. A clinical and electrophysiological study of 92 cases. Brain. 1987 Dec;110(Pt 6):1617–1630. doi: 10.1093/brain/110.6.1617. [DOI] [PubMed] [Google Scholar]
  7. McLeod J. G. Investigation of peripheral neuropathy. J Neurol Neurosurg Psychiatry. 1995 Mar;58(3):274–283. doi: 10.1136/jnnp.58.3.274. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Neundörfer B., Grahmann F., Engelhardt A., Harte U. Postoperative effects and value of sural nerve biopsies: a retrospective study. Eur Neurol. 1990;30(6):350–352. doi: 10.1159/000117372. [DOI] [PubMed] [Google Scholar]
  9. Notermans N. C., Wokke J. H., Franssen H., van der Graaf Y., Vermeulen M., van den Berg L. H., Bär P. R., Jennekens F. G. Chronic idiopathic polyneuropathy presenting in middle or old age: a clinical and electrophysiological study of 75 patients. J Neurol Neurosurg Psychiatry. 1993 Oct;56(10):1066–1071. doi: 10.1136/jnnp.56.10.1066. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Oh S. J. Diagnostic usefulness and limitations of the sural nerve biopsy. Yonsei Med J. 1990 Mar;31(1):1–26. doi: 10.3349/ymj.1990.31.1.1. [DOI] [PubMed] [Google Scholar]
  11. Rappaport W. D., Valente J., Hunter G. C., Rance N. E., Lick S., Lewis T., Neal D. Clinical utilization and complications of sural nerve biopsy. Am J Surg. 1993 Sep;166(3):252–256. doi: 10.1016/s0002-9610(05)80968-7. [DOI] [PubMed] [Google Scholar]
  12. Solders G. Discomfort after fascicular sural nerve biopsy. Acta Neurol Scand. 1988 Jun;77(6):503–504. doi: 10.1111/j.1600-0404.1988.tb05948.x. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES