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The role of skin biopsy in differentiating small-fiber neuropathy from ganglionopathy.
Eur J Neurol. 2018 06; 25(6):848-853.EJ

Abstract

BACKGROUND AND PURPOSE

We aimed to test the clinical utility of the leg:thigh intraepidermal nerve-fiber (IENF) density ratio as a parameter to discriminate between length-dependent small-fiber neuropathy (SFN) and small-fiber sensory ganglionopathy (SFSG) in subjects with signs and symptoms of small-fiber pathology.

METHODS

We retrospectively evaluated thigh and leg IENF density in 314 subjects with small-fiber pathology (173 with distal symmetrical length-dependent SFN and 141 with non-length-dependent SFSG). A group of 288 healthy subjects was included as a control group. The leg:thigh IENF density ratio was calculated for all subjects. We used receiver operating characteristic curve analyses to assess the ability of this parameter to discriminate between length-dependent SFN and SFSG, and the decision curve analysis to estimate its net clinical benefit.

RESULTS

In patients with neuropathy, the mean IENF density was 14.8 ± 6.8/mm at the thigh (14.0 ± 6.9/mm in length-dependent SFN and 15.9 ± 6.7/mm in patients with SFSG) and 7.5 ± 4.5/mm at the distal leg (5.4 ± 3.2/mm in patients with length-dependent SFN and 10.1 ± 4.6/mm in patients with SFSG). The leg:thigh IENF density ratio was significantly (P < 0.01) lower in patients with length-dependent SFN (0.44 ± 0.23) compared with patients with SFSG (0.68 ± 0.28). The area under the curve of the receiver operating characteristic analysis to discriminate between patients with length-dependent SFN and SFSG was 0.79. The decision curve analysis demonstrated the clinical utility of this parameter.

CONCLUSIONS

The leg:thigh IENF ratio represents a valuable tool in the differential diagnosis between SFSG and length-dependent SFN.

Authors+Show Affiliations

Department of Neurology, Istituti Clinici Scientifici Maugeri Spa SB - IRCCS di Telese Terme, Telese Terme (BN), Italy.Department of Neurology, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA.Department of Neurology School of Medicine, University of Minnesota, Minneapolis, MN, USA.IRCCS Institute of Neurological Sciences, University of Bologna, Bologna.Department of Neurology, Istituti Clinici Scientifici Maugeri Spa SB - IRCCS di Telese Terme, Telese Terme (BN), Italy.Department of Neurology School of Medicine, University of Minnesota, Minneapolis, MN, USA.Department of Neurology, Istituti Clinici Scientifici Maugeri Spa SB - IRCCS di Telese Terme, Telese Terme (BN), Italy.Department of Neurology, Istituti Clinici Scientifici Maugeri Spa SB - IRCCS di Telese Terme, Telese Terme (BN), Italy.IRCCS Institute of Neurological Sciences, University of Bologna, Bologna.Department of Neurology, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA.Department of Neurosciences Reproductive and Odontostomatological Sciences, University 'Federico II', Naples, Italy.Department of Neurology School of Medicine, University of Minnesota, Minneapolis, MN, USA.Department of Neurology, Istituti Clinici Scientifici Maugeri Spa SB - IRCCS di Telese Terme, Telese Terme (BN), Italy.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29493845

Citation

Provitera, V, et al. "The Role of Skin Biopsy in Differentiating Small-fiber Neuropathy From Ganglionopathy." European Journal of Neurology, vol. 25, no. 6, 2018, pp. 848-853.
Provitera V, Gibbons CH, Wendelschafer-Crabb G, et al. The role of skin biopsy in differentiating small-fiber neuropathy from ganglionopathy. Eur J Neurol. 2018;25(6):848-853.
Provitera, V., Gibbons, C. H., Wendelschafer-Crabb, G., Donadio, V., Vitale, D. F., Loavenbruck, A., Stancanelli, A., Caporaso, G., Liguori, R., Wang, N., Santoro, L., Kennedy, W. R., & Nolano, M. (2018). The role of skin biopsy in differentiating small-fiber neuropathy from ganglionopathy. European Journal of Neurology, 25(6), 848-853. https://doi.org/10.1111/ene.13608
Provitera V, et al. The Role of Skin Biopsy in Differentiating Small-fiber Neuropathy From Ganglionopathy. Eur J Neurol. 2018;25(6):848-853. PubMed PMID: 29493845.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The role of skin biopsy in differentiating small-fiber neuropathy from ganglionopathy. AU - Provitera,V, AU - Gibbons,C H, AU - Wendelschafer-Crabb,G, AU - Donadio,V, AU - Vitale,D F, AU - Loavenbruck,A, AU - Stancanelli,A, AU - Caporaso,G, AU - Liguori,R, AU - Wang,N, AU - Santoro,L, AU - Kennedy,W R, AU - Nolano,M, Y1 - 2018/04/06/ PY - 2017/12/21/received PY - 2018/02/26/accepted PY - 2018/3/2/pubmed PY - 2019/2/23/medline PY - 2018/3/2/entrez KW - immunohistochemistry KW - intraepidermal nerve fibers KW - neuropathic pain KW - sensory ganglionopathy KW - skin biopsy KW - small-fiber neuropathy SP - 848 EP - 853 JF - European journal of neurology JO - Eur J Neurol VL - 25 IS - 6 N2 - BACKGROUND AND PURPOSE: We aimed to test the clinical utility of the leg:thigh intraepidermal nerve-fiber (IENF) density ratio as a parameter to discriminate between length-dependent small-fiber neuropathy (SFN) and small-fiber sensory ganglionopathy (SFSG) in subjects with signs and symptoms of small-fiber pathology. METHODS: We retrospectively evaluated thigh and leg IENF density in 314 subjects with small-fiber pathology (173 with distal symmetrical length-dependent SFN and 141 with non-length-dependent SFSG). A group of 288 healthy subjects was included as a control group. The leg:thigh IENF density ratio was calculated for all subjects. We used receiver operating characteristic curve analyses to assess the ability of this parameter to discriminate between length-dependent SFN and SFSG, and the decision curve analysis to estimate its net clinical benefit. RESULTS: In patients with neuropathy, the mean IENF density was 14.8 ± 6.8/mm at the thigh (14.0 ± 6.9/mm in length-dependent SFN and 15.9 ± 6.7/mm in patients with SFSG) and 7.5 ± 4.5/mm at the distal leg (5.4 ± 3.2/mm in patients with length-dependent SFN and 10.1 ± 4.6/mm in patients with SFSG). The leg:thigh IENF density ratio was significantly (P < 0.01) lower in patients with length-dependent SFN (0.44 ± 0.23) compared with patients with SFSG (0.68 ± 0.28). The area under the curve of the receiver operating characteristic analysis to discriminate between patients with length-dependent SFN and SFSG was 0.79. The decision curve analysis demonstrated the clinical utility of this parameter. CONCLUSIONS: The leg:thigh IENF ratio represents a valuable tool in the differential diagnosis between SFSG and length-dependent SFN. SN - 1468-1331 UR - https://www.unboundmedicine.com/medline/citation/29493845/The_role_of_skin_biopsy_in_differentiating_small_fiber_neuropathy_from_ganglionopathy_ L2 - https://doi.org/10.1111/ene.13608 DB - PRIME DP - Unbound Medicine ER -