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Sural nerve biopsy: current role and comparison with serum neurofilament light chain levels

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Abstract

The diagnosis of peripheral neuropathies can be challenging with consequent difficulties in patients’ management. The aim of this study was to explore the current diagnostic role of sural nerve biopsy and to compare pathological findings with serum neurofilament light chain levels (NfL) as biomarkers of axonal damage. We collected demographic, clinical, and paraclinical data of patients referred over 1 year to the Neurology Unit, University of Verona, Italy, to perform nerve biopsy for diagnostic purposes, and we analyzed NfL levels in available paired sera using a high sensitive technique (Quanterix, Simoa). Eighty-two patients were identified (37.8% females, median age 65.5 years). Neuropathy onset was frequently insidious (68.3%) with a slowly progressive course (76.8%). Lower limbs were usually involved (81.7%), with a predominance of sensory over motor symptoms (74.4% vs 42.7%). The most common neuropathological findings were a demyelinating pattern (76.8%), clusters of regenerations (58.5%), and unmyelinated fibers involvement on ultrastructural evaluation (52.4%). A definite pathological diagnosis was achieved in 29 cases, and in 20.7% of patients, the referral clinical diagnosis was modified. Coexistent hematological conditions and hepatitis were diagnostic confounding factors (p = 0.012 and 0.034, respectively). In the analyzed paired sera (n = 37), an inverse despite not significant relationship between NfL values and fiber density was observed (Spearman’s rho − 0.312, p = 0.056). In addition, we noted increased serum NfL values of patients with active axonal degeneration. Nerve biopsy remains a useful diagnostic investigation to achieve a correct diagnosis and guide patients’ management in selected cases of peripheral neuropathy. Serum NfL is an accessible and potential valuable marker of axonal damage in these conditions.

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The corresponding author takes full responsibility for the data, the analyses and interpretation, and the conduct of the research.

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Acknowledgements

We would like to thank the Centro Piattaforme tecnologiche, University of Verona for providing the Quanterix, Simoa to measure NfL levels.

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Authors and Affiliations

  1. Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Policlinico GB Rossi, P.le LA Scuro 10, 37134, Verona, Italy

    Sara Mariotto, Sara Carta, Silvia Bozzetti, Cecilia Zivelonghi, Daniela Alberti, Salvatore Monaco, Tiziana Cavallaro & Sergio Ferrari

  2. Centro Piattaforme Tecnologiche, University of Verona, Verona, Italy

    Serena Zanzoni

  3. Neurology Clinic, Spedali Civili Hospital, Brescia, Italy

    Massimiliano Filosto

  4. Neurology Unit, S. Bonifacio Hospital, Verona, Italy

    Simone Fusina

  5. Department of Neurosciences, University of Padova, Padua, Italy

    Francesca Castellani & Chiara Briani

  6. Section of Endocrinology, Diabetes and Metabolism, University and Azienda Ospedaliera, Universitaria Integrata of Verona, Verona, Italy

    Alessandro Mantovani

Authors
  1. Sara Mariotto
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  2. Sara Carta
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  3. Silvia Bozzetti
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  4. Cecilia Zivelonghi
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  5. Daniela Alberti
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  6. Serena Zanzoni
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  7. Massimiliano Filosto
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  8. Simone Fusina
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  9. Salvatore Monaco
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  10. Francesca Castellani
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  11. Alessandro Mantovani
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  12. Tiziana Cavallaro
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  13. Chiara Briani
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  14. Sergio Ferrari
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Corresponding author

Correspondence to Sara Mariotto.

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Conflicts of interest

Sa.Ma. received support for attending scientific meetings by Merck and Euroimmun and received speaker honoraria from Biogen. SF received support for attending scientific meetings by Shire, Sanofi Genzyme, and Euroimmun. The other authors declare that they have no conflict of interest.

Ethics standards

All human studies have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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We collected consented to diagnostic procedures and biological sample storage at the referring laboratory for research use from all patients or legal representatives.

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Mariotto, S., Carta, S., Bozzetti, S. et al. Sural nerve biopsy: current role and comparison with serum neurofilament light chain levels. J Neurol 267, 2881–2887 (2020). https://doi.org/10.1007/s00415-020-09949-3

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  • DOI: https://doi.org/10.1007/s00415-020-09949-3

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