Publication details

Diagnostic validity of skin biopsy in painful sensory neuropathy utilising intra- and subepidermal nerve fiber densities

Authors

BEDNAŘÍK Josef VLČKOVÁ Eva DUŠEK Ladislav SOMMER C.

Year of publication 2006
Type Conference abstract
MU Faculty or unit

Faculty of Medicine

Citation
Description Evaluation of intra-epidermal nerve fiber density (IENFD) has become a standard tool in the diagnosis of painful sensory neuropathy. However, changes in the density of the subepidermal nerve plexus (SENFD) have never been systematically studied in neuropathy patients. Intra- and subepidermal nerve fiber densities were examined using PGP 9.5-immunostaining of skin-punch biopsy samples from the distal calf in 99 consecutively-recruited patients with clinical symptoms of a painful sensory neuropathy and with abnormal thermal thresholds on quantitative sensory testing (QST), and in 37 age-matched healthy volunteers. Comparison of the groups demonstrated a clear reduction in both IENFD and SENFD in the neuropathy group compared to the healthy controls (p<0.001). The diagnostic validity of IENFD and SENFD was assessed in receiver-operating characteristic curve (ROC) analysis. Using a cut-off value of 8.8 fibers/mm, the sensitivity of IENFD examination was 0.80 and the specificity 0.82. Evaluation of SENFD reached a sensitivity of 0.81 and a specificity of 0.88 for 7.25% as a cut-off point. The neuropathic group was further divided into two patient subgroups – pure SFN (pSFN) and mixed neuropathy subgroups (MFN) with concomitant nerve conduction abnormalities. Comparing these subgroups, no significant differences in intraepidermal innervation were found (p = 0.243), while the SENFD was markedly more reduced in patients with MFN (p<0.001). Despite close correlation between subepidermal and intra-epidermal nerve fiber densities, the ROC curve of the SENFD values allowed discrimination between pSFN and MFN patients.
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