Tenny Steven O, Schmidt Kyle P, Follett Kenneth A
Neurosurgery, University of Nebraska Medical Center, Omaha, USA.
Cureus. 2018 Oct 14;10(10):e3449. doi: 10.7759/cureus.3449.
Muscle biopsy is a common diagnostic marker for myopathy assessment; however, it has a relatively low pathologic yield of less than 60%. Additionally, both diagnostic and non-diagnostic muscle biopsies can provide guidance for treatment, i.e, provide therapeutic usefulness.
We designed a study to determine if having a documented definitive preoperative differential diagnosis would affect the pathologic yield and therapeutic usefulness of muscle biopsies for myopathy. Methods: This was a retrospective, single institution chart review of 106 consecutive muscle biopsies in adult patients, which looked at the presence or absence of a definitive preoperative differential diagnosis and relation to diagnostic yield and therapeutic usefulness of muscle biopsies. Results: Of 106 muscle biopsies, 50 biopsies (47%) had a definitive preoperative differential diagnosis, 52 biopsies (49%) returned definitive pathology, and 93 biopsies (88%) provided therapeutic information. The presence of a documented differential diagnosis increased the odds of pathologic yield by 3.73 (p-value < 0.01) and therapeutic usefulness by 3.40 (p-value 0.08). If pathology was diagnostic then the therapeutic usefulness of the biopsy was 4.54 times more likely (p-value < 0.01). Conclusion: Documentation of a definitive preoperative differential diagnosis, when pursuing muscle biopsy for myopathy, is associated with an increased pathologic diagnostic yield. Definitive pathology was associated with an increase in the therapeutic usefulness of the muscle biopsy.
肌肉活检是评估肌病的常见诊断标志物；然而，其病理诊断率相对较低，不到60%。此外，诊断性和非诊断性肌肉活检都可为治疗提供指导，即具有治疗价值。
我们设计了一项研究，以确定术前有明确的鉴别诊断记录是否会影响肌肉活检对肌病的病理诊断率和治疗价值。方法：这是一项对成年患者连续106例肌肉活检进行的回顾性单机构病历审查，研究术前是否存在明确的鉴别诊断以及与肌肉活检的诊断率和治疗价值的关系。结果：在106例肌肉活检中，50例（47%）术前有明确的鉴别诊断，52例（49%）得出明确的病理结果，93例（88%）提供了治疗信息。有鉴别诊断记录使病理诊断率的几率增加3.73（p值<0.01），治疗价值增加3.40（p值0.08）。如果病理诊断明确，那么活检的治疗价值可能性高4.54倍（p值<0.01）。结论：在对肌病进行肌肉活检时，术前明确的鉴别诊断记录与病理诊断率的提高相关。明确的病理结果与肌肉活检治疗价值的增加相关。
