Nerve Biopsy
Muscle Biopsy

MATERIALS AND EQUIPMENT:

1. Gauze 4" x 4"
2. Specimen zip-lock bags
3. Wet ice
4. Patient ID labels 
5. Pathology requisition
6. Face-sheet

• The muscle biopsies should contain at least three (3) 1.5 cm x 1.0 cm x 1.0 cm portions of muscle to provide a representative sample and enough tissue for quantitative studies if necessary.
• Single samples should be avoided if possible. 
• Samples do not need to be submitted on a clamp.
• Specimens removed from the Quadriceps or Biceps yield superior results; the Gastrocnemius muscle should be avoided.
• Cautery destroys enzymes in muscle specimens, therefore surgical specimens should not be obtained using laser or electrocautery devices.
• Specimens should not be placed directly into saline due to ice crystal formation during processing.

• The nerve biopsy should be submitted intact and approximately 5 cm in length to allow for adequate fiber teasing, frozen longitudinal and cross-sections.  All of these tests are necessary for a complete nerve study.
• The specimen should be visually inspected for the presence of white glistening fascicles in bundles.  The specimen should include epineurium, perineurium and endoneurium.

• Obtain the muscle or nerve biopsy sample(s).
• Place each muscle or nerve biopsy sample in a minimally saline-dampened gauze and insert each wrapped sample in a separate zip-lock bag, zipping the bag closed.
  • Excessive saline distorts the sample, so the gauze should be minimally damp with dry corners or squeezed out and the excess saline discarded. 
• Place a patient ID label on the outside of each zip-lock bag indicating the date/time of collection, initials of collector and the source of the biopsy.
• Place all of the individual bags in another zip-lock back with the completed requisition and face sheet in the pocket.
  • Caution! Do not use freezer ice packs for transport!  They are too cold and may freeze the specimens en route!  Transport on regular ice or store in refrigerator.  Do not put any ice inside the zip-lock bag!  
• Transport to the Laboratory and process within two hours (sooner if possible).  In an emergency, the samples may be left (still wrapped) in the refrigerator overnight.
• The entire specimen is then sent by overnight transport to UCLA, Department of Pathology, for processing, evaluation and interpretation.  These fresh samples can only be shipped Monday through Thursday.  Friday obtained biopsies can not be processed at UCLA until Tuesday and may be suboptimal due to delayed processing at their site.