Muscle and nerve biopsy protocol
From 4 October 2022, the Department of Clinical Neuropathology has transferred to Synnovis LLP (a partnership between Guy’s and St Thomas’ and King’s College Hospital NHS Foundation Trusts, and SYNLAB UK & Ireland).
The department receives around 250 muscle and around 30 nerve biopsies each year, and is a major referral centre for muscle and nerve diseases. We use comprehensive immuno-stains for inflammatory myopathy and sarcolemmal protein for muscular dystrophy. A panel of immunohistochemistry, semi-thin sections and electron microscopy is used to investigate the nerve biopsies. There are regular weekly meetings with neurologists and neurophysiologists to discuss cases.
1. Phone us in advance
Contact the Neuropathology Laboratory at King’s College Hospital on 020 3299 1957 the day before the procedure and give a rough time when the biopsy is being taken and the patient’s name. If there is no answer, then phone the department office on 020 3299 1955 and leave a message. The department is open from 8.30am to 5pm, Monday to Friday.
Please phone the department as soon as possible to notify us of any changes or cancellations.
2. How to take biopsies
Unless specifically indicated/contra-indicated by the patient’s condition, the muscle of choice to biopsy is the quadriceps or biceps and the nerve of choice is the sural. The volume of tissue required is approximately 1 cubic cm for muscle and 1-3cm in length for nerve. The muscle should be removed as an open biopsy without local use of diathermy or cortory. The sample must not be clamped or tied to a stick. Biopsies obtained by the use of ‘guns’ should be avoided since the reconstruction necessary makes sample interpretation very difficult. The nerve should be removed by open biopsy.
Two biopsies can be sent at the same time, as long as they reach the laboratory within the required timeframe. It will be cheaper to send two together, rather than using a separate courier for each sample.
3. When to take biopsies
The biopsies should all to be done in the morning, and preferably as early as possible, in order to allow a reasonable time for the dissection and selection of samples for freezing and other procedures. We do not accept biopsies arriving later than 4pm at our laboratory.
4. How to package and transport the sample
Please send samples immediately following the procedure (time is imperative for sample integrity especially for tests involving EM ultrastructural analysis and enzyme work).
Muscle samples should be placed in a universal container without anything else added. Wrap this in a specimen bag or a single layer of bubble wrap. This wrapped pot should then be shipped on wet ice or a cool pack. Please package the specimen so that it stays cold, but do not freeze. Please do not use dry ice as this will cause morphological artefacts on microscopic visualisation of samples.
For nerve biopsies the same procedure should be followed if samples are sent fresh. However, to ensure better preservation, we would prefer to send referral centres pre-made fixatives prior to procedure taking place. One sample of approximately >1cm should be placed in a glutaraldehyde tube for EM testing and one in formalin (for histology) immediately after removal of tissue at operation. Please take care not to damage the tissue by handling with forceps. Drop the tissue directly into each tube avoiding contact of forceps with the fixative. Use appropriate PPE and handle with caution as fixatives are toxic. Please contact the lab in advance so that we can send you the fixatives. If you send samples to us on a regular basis we can distribute a batch of fixatives to you in advance, providing you have the facilities to keep them in -20C freezer and defrost prior to the procedure. Alternatively, we can send you fresh fixatives just before the operation; these should be kept in the fridge and used within two days of receipt.
Please do not:
- submerge the specimen in any liquid (for example, saline)
- wrap the sample in gauze
- freeze the sample or transport it on dry ice, unless instructed to do so (call the laboratory on 020 3299 1957 if unsure).
A letter explaining the clinical details, plus any other useful information, such as the EMG report, must accompany the sample. Please clearly state the patient's consultant details along with the address or a secure email address to send the report to. It should be sent by courier to arrive in this department within one hour of taking the biopsy. The packaging must consist of the following:
- a primary receptacle
- a leak-proof secondary packaging
- an outer packaging with minimum dimensions of 100x100mm
- the complete package shall be capable of withstanding a drop of 1200mm
The package must be labelled UN3373, contained within a diamond shape with minimum dimensions of 50x50mm. The proper shipping name – Biological Substances, Category B – must be marked adjacent to the label.
It is the sender’s responsibility to comply with these regulations.
Mark the package as:
‘Urgent sample from for Department of Clinical Neuropathology, 1st Floor, Academic Neuroscience Centre, King’s College Hospital, Denmark Hill, London SE5 9RS. Telephone: 020 3299 1957’
Tell the courier that the Academic Neuroscience Centre is located on Denmark Hill. There is a buzzer entry system and they will need to press the button marked ‘Clinical Neuropathology’. The secretary will then direct them to the laboratory on the first floor. Please phone the laboratory on 020 3299 1957 when the courier has left your hospital. If the courier has difficulty finding the department, or nobody answers the buzzer, they should phone the laboratory for local directions or so someone from the laboratory can meet them at the entrance to the building.
If you have any difficulties or questions, in the first instance contact Nelly Ritcheva
on 020 3299 1957.
Alternatively, phone Ashley Kilner, Quality Manager, on 020 3299 1951.