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Nerve Biopsy, Fresh Tissue

Department

Histology

Instructions

• Beaumont Laboratory strives to provide preliminary results via a phone call regarding presence or absence of inflammation or vasculitis, and discuss other relevant findings with the patient's Neurologist, Rheumatologist, Internal Medicine physician, Pediatric physician, or other clinician within one to two business days of receiving the biopsy. This service can only be provided if the proper contact information is provided in the submitted paperwork.
  
  
• The specimen must be accompanied by:

Outreach
Muscle Biopsy, Beaumont Laboratory Outreach
Requisition 5728 031910 OS8

• Electronic Ordering with generation of paper requisition: EPIC Optime/Navigator order “LAB6798 Surgical Pathology Tissue.”
  

• Each specimen requisition must include patient's full name, date of birth, patient's social security number (only last 4 of SSN), hospital number including visit number, authorizing physician and/or clinician name, specimen source including identifiers and pre-op diagnosis. For proper patient care and pathologic examination, the name and phone number of the Neurologist and/or Rheumatologist is required.

• Follow-up on cases is always appreciated. Please contact Beaumont Laboratory by call 800-551-0488, Option 5, to comment on your service. Thank you for allowing Beaumont Laboratory to participate in the care of your patient(s).
  
  

Royal Oak

• Royal Oak Surgical Pathology/Histology laboratory processes all nerve biopsies.
  
  
• Surgery for nerve biopsies needs to be scheduled in the day so that the nerve biopsy is RECEIVED in Royal Oak Surgical Pathology/Histology Laboratory prior to 3:00 pm, Monday – Friday. Nerve biopsies should not be performed on weekends.
  

Non-Royal Oak acute care campuses (Dearborn, Troy, Farmington Hills, Grosse Pointe, Taylor, Trenton, Wayne)

• Please notify the histology laboratory 24 hours in advance by calling (see below) during normal hours of operation. The laboratory will notify Royal Oak of pending biopsy.
  
  
• Muscle biopsies should be scheduled between the hours of 7:00 am and 12:00 pm to allow for time needed to transport specimen to Royal Oak for processing.
  
  
• Muscle biopsies should be placed in a muscle clamp if possible and gently wrapped in saline moistened gauze and placed in a sterile container with all necessary patient information including source and site of biopsy. DO NOT PLACE BIOPSY IN FORMALIN.
  
  
• Please include "surgical specimen requisition/order" form with necessary patient information to include the source and site of specimen.

Specimen Collection Criteria

Collect: Biopsy specimen collected as described below:

• Specimens at Beaumont Health, Royal Oak: Sharply dissect a portion of peripheral nerve, measuring at least 2.0-3.0 cm long, gently wrapped in saline-moistened gauze (not floating in saline as this causes artifact), placed into an air tight specimen container and delivered to Anatomic/Surgical Pathology immediately. The specimen container must be labeled with the patient's full name (first and last), date of birth, hospital number including visit, specimen source and site (for example "left sural nerve").
  
  
• Specimens at Beaumont Health, Troy, Grosse Pointe, Farmington Hills, Dearborn, Trenton, Taylor and Wayne: If the specimen is sent out immediately to Royal Oak, send in saline moistened gauze and placed into an air-tight container. The container is placed within a cooler on wet ice or cooling pack but NOT FROZEN.
  
  
• Specimens from non-Beaumont Health facilities: The nerve biopsy should be at least 2.0-3.0 cm long and cut in half with a new scalpel or razor blade. One portion should be stretched gently onto a piece of cardboard (alternatively may pin or tie onto a portion of wooden tongue depressor) then placed into a specimen container filled with 10% Neutral Buffered Formalin and left at room temperature. The other portion should be stretched gently on a piece of cardboard and placed in 2-5% buffered glutaraldehyde. The specimen should be refrigerated, but NOT FROZEN. A Muscle/Nerve Biopsy, Beaumont Laboratory Outreach requisition 5728 031910 OS8 must be completed by the attending physician or surgeon. This requisition must accompany all specimens. The following information is required: Date of birth, full patient name (first and last), the physician to receive the report, specimen type and site (for example "left sural nerve").

Physician Office/Draw Specimen Preparation

• Hospitals close to Beaumont Health should deliver the fresh specimen immediately to Anatomic /Surgical Pathology via a courier/transportation service chosen by the facility sending the specimen. STAT transportation can be arranged by calling Beaumont Laboratory Outreach 800-551-0488. Ship fresh, unfixed specimens wrapped in saline moistened gauze in a water-tight small specimen container that is placed on wet ice or a cool pack, but NOT FROZEN. The specimen should always be handed to one of the surgical pathology assistants.
  
  
• Hospitals far from Beaumont Health need to send the specimen by express courier to the Department of Anatomic/Surgical Pathology following OSHA regulations. The formalin and glutaraldehyde fixed tissue should be stored in a refrigerator (NOT FROZEN) until shipped at room temperature (20-26°C or 68-78.8°F).

Preparation for Courier Transport

Transport: Biopsy specimen prepared as described above, at room temperature (20-26°C or 68-78.8°F) or refrigerated (2-8°C or 36-46°F). Specimens are hand delivered to Surgical Pathology.

Rejection Criteria

• There are no rejection criteria.
• Delay in processing of the fresh nerve biopsy will affect the staining and diagnosis.
• Any missing information will also delay processing and final diagnosis.  

Inpatient Specimen Preparation

Fresh nerve biopsies should always be delivered immediately to Surgical Pathology and should be handed to one of the Surgical Pathology assistants. NEVER leave a fresh muscle biopsy in the specimen pick-up area.

In-Lab Processing

Nerve biopsy is cut into 2 roughly equal portions. One portion is placed into 10% Neutral Buffered Formalin and processed by Histology. The other portion is placed into 2-5% glutaraldehyde and processed by Electron Microscopy (EM). If adequate tissue is provided and the clinical history suggests the need for additional studies, tissue may be submitted for nerve tease preparation.

Storage

Specimen Stability for Testing:

Specimens are processed immediately upon receipt in the Laboratory.

Specimen Storage in Department Prior to Disposal:

After case is signed-out: Hematoxylin and eosin stained sections of formalin-fixed tissue and frozen tissue can be sent to the submitting hospital's Pathology Department. The remainder of the slides, paraffin blocks, EM blocks, grids and photomicrographs are retained at Beaumont Hospital, Royal Oak.

Laboratory

Royal Oak Surgical Pathology/Histology Laboratory*.
*All specimens are processed at Royal Oak, however specimens may be procured at Troy and Grosse Pointe. 

Dearborn Surgical Pathology/Histology Laboratory
Farmington Hills Surgical Pathology/Histology Laboratory
Grosse Pointe Surgical Pathology/Histology Laboratory
Taylor Surgical Pathology/Histology Laboratory
Trenton Surgical Pathology/Histology Laboratory
Troy Surgical Pathology/Histology Laboratory
Wayne Surgical Pathology/Histology Laboratory

Performed

Monday – Friday, 6:00 am – 3:00 pm.
Results available within 1 week or less for inflammatory cases, 1-2 weeks for more complex cases.

Test Methodology

• Routine Processing with Hematoxylin and Eosin stained slides prepared from formalin fixed tissue.
• Special staining procedures: Masson trichrome, Congo-red, S100, Neurofilament.
• Electron microscopy: Methylene Blue Azure stained semi-thin sections, ultrastructural study.
• Nerve Tease Preparation.

Interpretation

Microscopic diagnosis of prepared slides and ultrastructural photomicrographs.

Contacts

Last Updated

11/8/2022