Specimen Collection & Transport
Nerve Biopsy Consultation Kit Instructions
Nerve biopsies are performed in the evaluation of patients with neuromuscular or metabolic disease.
These specimens require highly specialized tissue handling and staining procedures and interpretation by a neuromuscular pathologist. A comprehensive panel of special stains and light microscopic evaluation of glutaraldehyde-fixed resin-embedded tissue is performed on all specimens.
The best value for the patient is achieved when the treating physician provides pertinent clinical information, the surgeon removes an adequate specimen, and the local pathology laboratory packs the specimen properly and ships it promptly. Our Nerve Biopsy Consultation Kit provides the necessary materials to ensure specimen integrity during shipment to our laboratories.
Specimen Collection & Transport
Overview
Whenever possible, biopsies should be scheduled Monday–Thursday.
If the biopsy must be performed on a Friday, or if the specimen is originating from outside the continental United States, ask the local pathology laboratory to contact the Surgical Pathology Desk for additional information.
Nerve biopsies are performed in the evaluation of patients with neuromuscular or metabolic disease. The procedure is requested by the treating physician, usually a neurologist or rheumatologist, and performed by a surgeon.
These specimens require highly specialized tissue handling and staining procedures and interpretation by a neuromuscular pathologist. A comprehensive panel of special stains and light microscopic evaluation of glutaraldehyde-fixed resin-embedded tissue is performed on all specimens.
Additional studies, including electron microscopy and immunohistochemistry, will be performed at the discretion of the neuromuscular pathologist based upon the light microscopic findings and clinical information provided. The best value for the patient is achieved when the treating physician provides pertinent clinical information, the surgeon removes an adequate specimen, and the local pathology laboratory packs the specimen properly and ships it promptly.
Muscle biopsies are often performed at the time of nerve biopsy. Muscle biopsies have different handling requirements; see our Muscle Biopsy Consultation Kit Instructions for details.
Requisition
Prior to requesting a biopsy, the treating physician should obtain and complete a Muscle / Nerve Surgical Requisition.
Fill the form out completely and provide it to the surgeon prior to the date of surgery.
Specimen Requirements
The specimen should be a portion of whole nerve (not a single fascicle) measuring 2 cm or longer.
Specimens should be handled by the ends with fine forceps. Take care not to pinch.
The surgeon should be instructed to place the specimen on Telfa gauze moistened with saline and to deliver the specimen promptly to the Pathology Laboratory.
A completed Muscle / Nerve Requisition should accompany the specimen.
Whenever possible, biopsies should be scheduled Monday–Thursday.
If the biopsy must be performed on a Friday, or if the specimen is originating from outside the continental United States, ask the local pathology laboratory to contact the Surgical Pathology Desk for additional information.
The specimen must not be immersed in saline.
Shipping Preparation
Fresh specimens should be shipped for arrival in our laboratory prior to 5 p.m. by same day or overnight courier service.
Contact the Surgical Pathology Desk to alert the lab for any case expected to arrive on a Saturday.
1. Delicately lay the specimen onto a piece of “card-stock”-weight paper that is a few millimeters longer than the specimen.
- Wait for one to two minutes to permit adherence of the nerve to the paper.
2. Use a sharp blade to cut the nerve perpendicular to the long axis into two segments of equal length.
- Use firm pressure to cut through the nerve and paper.
3. If 2-4% buffered glutaraldehyde is available, place one segment of the specimen in glutaraldehyde and the other into a container of 10% neutral buffered formalin.
- If glutaraldehyde is unavailable, place both segments into 10% neutral buffered formalin (included in the kit), and our laboratories will post-fix upon receipt.
4. Label all specimen parts with two of three patient identifiers:
- Patient name
- Date of birth
- Social security number
5. Place specimen containers in a sealable plastic bag with an absorbent pad.
6. Secure the bagged specimens in between the foam inserts provided with the kit, then place them into the green box.
7. Place the completed requisition into the green shipping box, then close the box.
If a muscle biopsy was performed during the same procedure and is being shipped separately, please indicate this on the requisition.
8. Place the green box into the Laboratory Pak and seal.
9. Affix the provided shipping label to the Laboratory Pak.
- Ship the specimen Next-Day Air to:
Cleveland Clinic Laboratories
L15 – Pathology & Laboratory Medicine
2119 E 93rd Street
Cleveland, OH 44106
Laboratory Contact Information
Surgical Pathology Desk
216.444.2836
Contact the Surgical Pathology Desk for technical tissue handling and shipping questions.
Neuromuscular Pathology Secretary
216.444.2843
Contact the Neuromuscular Pathology Secretary to arrange to speak with a pathologist regarding medical pathology questions, including specific tests offered, their indications, and interpretations.