Abstract
BackgroundThe determination of Intraepidermal Nerve Fiber Density (IENFD) in skin biopsy is a useful method for the evaluation of different types of peripheral neuropathies. To allow a reliable use of the method it is necessary to determine interobserver reliability. Previous studies dealing with this topic used limited suitable statistical methods.MethodsIn the present study three observers determined the IENFD and estimated the staining quality of the basement membrane for an adequate quantity of 120 skin biopsies (stained with indirect immunofluorescence technique) from 68 patients. More adequate statistical methods like intraclass correlation coefficient and Bland Altman Plot were chosen to estimate interobserver reliability.ResultsWe found an unexpected significant difference in IENFD between the observers (p < 0.05) and so the results of this study are not in line with the high interobserver reliability reported before (intraclass correlation coefficient: 0.73). The Bland Altmann Plot showed a variance growing with rising mean. The difference in IENFD between the observers and the resulting low interobserver reliability is likely caused by different interpretations of the standard counting rules. There was no significant difference in IENFD between observers for biopsies with a well-defined basement membrane. Thus skin biopsies with an inexactly defined basement membrane should not be used diagnostically for the determination of IENFD.ConclusionThese results emphasise that standardisation of the method is extremely important and at least two observers should analyse skin biopsies with critical IENFD near the cut-off values.
Highlights
The determination of Intraepidermal Nerve Fiber Density (IENFD) in skin biopsy is a useful method for the evaluation of different types of peripheral neuropathies
In 2005 Lauria et al published the guidelines of the European Federation of Neurological Societies (EFNS) on the use of skin biopsy and the determination of intraepidermal nerve fibers (IENF) density (IENFD) in the diagnosis of peripheral neuropathy [6]
2.1 Patients Skin biopsies from 68 patients were examined, who all previously participated in several independent studies designed to examine the validity of quantitative sensory testing (QST) and to determine the IENFD in skin biopsy
Summary
The determination of Intraepidermal Nerve Fiber Density (IENFD) in skin biopsy is a useful method for the evaluation of different types of peripheral neuropathies. Despite the fact that numerous patients in pain or neurology departments are admitted for typical neuropathic symptoms such as paraesthesia and dysaesthesia the conventional diagnostic methods such as nerve conduction studies and electromyography often do not show patho-. Immunohistochemical illustration of the intraepidermal nerve fibers (IENF) in skin biopsy and quantitative sensory testing (QST) are two new diagnostic methods to objectify the disorders of some of these patients [5]. In 2005 Lauria et al published the guidelines of the European Federation of Neurological Societies (EFNS) on the use of skin biopsy and the determination of IENF density (IENFD) in the diagnosis of peripheral neuropathy [6]. Two or more observers conduct the same test and their accordance is subsequently analysed
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