Test Code SPBX Epidermal Nerve Fiber Density Consultation, Varies
Shipping Instructions
Transport specimen per instructions on the Epidermal Nerve Fiber Density Preparation Instructions (T703).
Necessary Information
All requisition and supporting information must be submitted in English.
Each of the following items is required:
1. All requisitions must be labeled with:
-Patient name, date of birth, and medical record number
-Name and phone number of the referring pathologist or ordering provider
-Anatomic site and collection date
2. Epidermal Nerve Fiber Density Patient Information (T702)
3. Additional clinical information:
-Neurology clinical notes
-Electromyography results if performed
Specimen Required
Preferred:
Specimen Type: Skin punch biopsy
Supplies: Skin Punch Biopsy Kit (to order call either 507-284-8065 or 800-533-1710) containing fixatives, buffer, and cryoprotectant
Source: Distal leg, mid-thigh, dorsal foot, or lower abdomen
Container/Tube: A Skin Punch Biopsy Kit is required (no substitutions accepted) for collection.
Collection Instructions:
1. The standard biopsy for evaluating distal small fiber sensory neuropathy includes two 3-mm skin punch biopsies from the same side of the body.
2. Prepare specimen per instructions on the Epidermal Nerve Fiber Density Preparation Instructions (T703).
Acceptable:
Specimen Type: PGP 9.5-reacted slides
Additional Information:
1. At least one slide reacted with PGP 9.5, using a PGP 9.5 protocol for visualizing epidermal nerve fibers, is required.
2. At least one hematoxylin and eosin-stained slide and one Congo red-stained slide are optional.
Specimen Type: PGP 9.5-reacted slides and tissue block
Note: Visualization of epidermal nerve fibers cannot be done on paraffin blocks.
Additional Information:
1. At least one slide reacted with PGP 9.5, using a PGP 9.5 protocol for visualizing epidermal nerve fibers, is required.
2. Tissue block may only be used to create hematoxylin and eosin-stained slides and Congo red-stained slides.
Forms
Epidermal Nerve Fiber Density Patient Information (T702) is required.
Useful For
Investigating polyneuropathies
Disease States
- Small fiber neuropathy
- Polyneuropathies
Reflex Tests
Test ID | Reporting Name | Available Separately | Always Performed |
---|---|---|---|
SS2PC | SpecStain, Grp II, other | No, (Bill Only) | No |
COSPC | Consult, Outside Slide | No, (Bill Only) | No |
CUPPC | Consult, w/USS Prof | No, (Bill Only) | No |
CRHPC | Consult, w/Comp Rvw of His | No, (Bill Only) | No |
MANPC | Morph Analysis, Nerve | No, (Bill Only) | No |
LV4RP | Level 4 Gross and Microscopic, RB | No, (Bill Only) | No |
CSPPC | Consult, w/Slide Prep | No, (Bill Only) | No |
EM | Electron Microscopy | Yes | No |
IHPCI | IHC Initial | No, (Bill Only) | No |
Testing Algorithm
A battery of enzyme histochemical stains or immunostains are performed; other tests can be performed, as indicated, at an additional charge.
Wet tissue for consultation: When adequately prepared tissue is provided, routine testing will include PGP 9.5 (protein gene product 9.5) immunostain, morphometric analysis, Congo red stain, and hematoxylin and eosin stain. PGP 9.5 reactions cannot be done on previously embedded tissue, eg, paraffin blocks, epoxy blocks.
Slides and blocks sent for consultation must include PGP 9.5-reacted sections:
Special stains and studies performed on the case should be sent with the case for review. In order to determine an accurate diagnosis, some of these stains or studies may be deemed to warrant repeat testing, at an additional charge, at the discretion of the reviewing Mayo Clinic neuromuscular pathologist. In addition, testing requested by the referring physician (immunostains, molecular studies, etc) may not be performed if deemed unnecessary by the reviewing Mayo Clinic neuromuscular pathologist. For all consultations, ancillary testing necessary to determine a diagnosis is ordered at the discretion of the Mayo Clinic neuromuscular pathologist. An interpretation, which includes an evaluation of the specimen and determination of a diagnosis, will be provided within a formal pathology report.
For more information see Pathology Consultation Ordering Algorithm.
Special Instructions
Reporting Name
Epidermal Nerve Fiber DensitySpecimen Type
VariesSpecimen Stability Information
Specimen Type | Temperature | Time | Special Container |
---|---|---|---|
Varies | Refrigerated (preferred) | ||
Ambient |
Reject Due To
All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.Reference Values
An interpretive report will be provided.
Supportive Data
Investigators at Mayo Clinic (Bolton, Winkelmann, Dyck) did previous work on cutaneous receptors preceding the recent work on intraepidermal nerve fiber densities. With recent findings, PJ Dyck and colleagues have developed the technique to national standards.(7)
Day(s) Performed
Monday through Friday
Report Available
7 to 14 days: Cases requiring additional material or ancillary testing may require additional time.Specimen Retention Time
Slides and blocks: IndefinitelyPerforming Laboratory
Mayo Clinic Laboratories in RochesterCPT Code Information
88305 (if appropriate)
88313 (if appropriate)
88321 (if appropriate)
88323 (if appropriate)
88323-26 (if appropriate)
88325 (if appropriate)
88348 (if appropriate)
88356 (if appropriate)
88342 (if appropriate)
LOINC Code Information
Test ID | Test Order Name | Order LOINC Value |
---|---|---|
SPBX | Epidermal Nerve Fiber Density | In Process |
Result ID | Test Result Name | Result LOINC Value |
---|---|---|
601780 | Interpretation | 59465-5 |
601791 | Participated in the Interpretation | No LOINC Needed |
601792 | Report electronically signed by | 19139-5 |
601793 | Addendum | 35265-8 |
601794 | Gross Description | 22634-0 |
601795 | Material Received | 81178-6 |
601824 | Case Number | 80398-1 |
601913 | Disclaimer | 62364-5 |