What is the role of biopsy in the workup of polyarteritis nodosa (PAN)?

Updated: Nov 14, 2017
  • Author: Dana Jacobs-Kosmin, MD, FACP; Chief Editor: Herbert S Diamond, MD  more...
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Answer

When possible, a biopsy sample of involved, accessible tissue should be collected to aid in the diagnosis. The most accessible tissue sites for biopsy include the skin, sural nerve, testes, and skeletal muscle. The results of a retrospective study suggest muscle biopsy may be helpful for the diagnosis of systemic vasculitides, even in the absence of myalgias or creatine kinase level elevation. [52] Kidney biopsy carries a risk of aneurysmal rupture and bleeding.

Biopsies should be performed correctly to allow for adequate sampling of medium-sized arteries. Biopsy samples of skin nodules or ulcers should be collected at the edges and include deep dermis and subcutaneous fat. [6] In addition, nearby central ulcer areas, including subcutaneous tissue, should be included to increase diagnostic yield. [53]

Biopsy of small arteries from the abdominal viscera in conjunction with arteriography facilitates identification of the vasculitis.

Combined nerve and muscle biopsy is preferred. Biopsy of the sural nerve should be full-thickness to include epineural vessels. [43]


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