Re: Needle Muscle Bx's

From:Ronnie Houston

I have been working with muscle biopsies since the late 70's, both needle and open.

There is one easy answer to all your questions: it all depends on the expertise of the physician performing the technique. It is not as easy as it may sound or indeed looks to perform a needle biopsy, so I would not suggest changing to this without assurance that you are going to achieve adequate sampling.

My mentor, David Doyle, MD, in Glasgow perfected his technique on corpses before using it on the living. We performed it on both adults, children and even neonates with excellent results,- even on advanced Duchenne's muscular dystrophy and end stage muscle.

It  was easy to obtain enough muscle for routine histochemistry, immunohistochemistry, EM, biochemical anaylsis and Western Blotting.
We used a 4mm needle for children (occasionally 3mm for neonates)  and 5mm needle for adults. It is important that the needles are regularly sharpened.

Dr Doyle used to get multiple samples by rotating the needle and "cutting" two or three times before withdrawing the needle. It is also possible to probe  again on several occasions, with minimal trauma. We did not apply suction, as is the case here in Texas; never found a need for it.
I have indeed performed the technique on animal tissue with great results.

I have to say though, that I have not seen that same success rate by many others outside Glasgow, and certainly now, most of our biopsies here are open.

It is equally important to have the sample orientated correctly by technical staff before freezing. This may necessitate the biopsy being teased apart put aligning all the fibers in the correct plane before attaching to cork and snap-freezing; and this can cause some problems especially with very young muscle.

If I was answering this question from Glasgow, I would say that it is preferable to perform needle biopsy, as there is less trauma to the muscle  (and the patient) and the procedure can be performed on an out-patient basis in a clinic setting, with only local anaesthesia.

However, unless you can be assured that, whoever is performing the surgery is suitably adapt, and that your technical staff would be able to orientate the specimen correctly, I would say stay away from needles and concentrate on getting adequate samples by an open technique.

It should be added that needle biopsy is not suitable if wanting to assess motor end-plates, as in myastheia gravis.

If there is anything else you need to know, don't hesitate to ask.

Best wishes

Ronnie Houston
Cytochemistry & Molecular Pathology
Texas Scottish Rite Hospital for Children
2222 Welborn Street
Dallas, TX 75219
(214) 559 7744
(214) 559 7768 - fax

>>> "Mitchell (Jean)"  12/17/01 08:50AM >>>
I am looking for some info/feedback from labs working with muscle 
bx's.  More specifically comparing open muscle bx's to needle muscle 

For those working with needle bx's:
Is this procedure done on both children & adults?
Is it routinely done or only under certain circumstances?
Do you receive adequate amounts of tissue? (for frozen & EM)
Is one bx taken or multiple samples obtained from the same area?
What size needle is most often employed?
Is there a preference in open vs needle bx's or do you find better 
results in one over the other?

Thanks much,

Jean Mitchell, BS, HT (ASCP)
University of Wisconsin Hospital & Clinics
Department of Neurology, Neuromuscular Laboratory
Madison, WI

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