Muscle biopsy practices in the evaluation of idiopathic inflammatory myopathies: An international survey of expert clinicians

IF 4.6 2区 医学 Q1 RHEUMATOLOGY
Samuel Maxwell , Laura Ross , Shereen Oon , Ian P. Wicks , Jessica Day
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引用次数: 0

Abstract

Background

Muscle biopsy is an important test in the evaluation of individuals with suspected myopathy, including those with suspected idiopathic inflammatory myopathy (IIM). Various approaches, including open surgical biopsy, needle biopsy and conchotome forceps, have been reported. However the real-world utilisation of these approaches remains unclear. There are no established guidelines for the use of muscle biopsy, or selection of biopsy technique, in investigating IIM and international practices are not well-documented. This study describes current approaches to muscle biopsy amongst clinicians with expertise in IIM.

Methods

A survey regarding muscle biopsy practices was disseminated among members of the International Myositis Assessment and Clinical Studies (IMACS) group. Data were analysed using descriptive statistics.

Results

One-hundred and sixteen clinicians completed the survey, primarily rheumatologists. Open surgical biopsy was the most commonly employed technique (74.5 %), followed by needle (11.3 %) and conchotome (9.4 %) approaches. Clinical examination was the most common method of muscle selection, with 85.2 % of respondents reporting they ‘always or almost always’ relied on it. MRI and electromyography were also frequently utilised for muscle selection (51.9 %, 45.4 % respectively). There was variability in the perceived utility of muscle biopsy in certain clinical contexts, such as presence of myositis specific antibodies or cutaneous manifestations of dermatomyositis. While respondents generally reported low complication rates following muscle biopsy, non-diagnostic histopathology was commonly reported, regardless of procedural approach.

Conclusion

Clinicians managing IIM report muscle biopsy to be well tolerated however, non-diagnostic results are common. Substantial heterogeneity regarding perceived indications for biopsy, procedural approaches, and muscle selection strategies were observed within this expert group. Future research is needed to establish best practice and determine the role of muscle biopsy in the context of continued advancements in serological profiling of IIM.

评估特发性炎症性肌病的肌肉活检方法:临床专家国际调查
背景肌肉活检是评估疑似肌病患者(包括疑似特发性炎症性肌病(IIM)患者)的一项重要检查。目前已报道了多种方法,包括开放手术活检、针刺活检和海螺钳活检。然而,这些方法在现实世界中的使用情况仍不明确。在调查 IIM 时,没有关于使用肌肉活检或选择活检技术的既定指南,国际惯例也没有详细记录。本研究介绍了具有 IIM 专业知识的临床医生目前采用的肌肉活检方法。方法:在国际肌炎评估和临床研究(IMACS)小组成员中开展了一项关于肌肉活检方法的调查。结果 116 名临床医生完成了调查,其中主要是风湿免疫科医生。开放手术活检是最常用的技术(74.5%),其次是针刺法(11.3%)和锥切法(9.4%)。临床检查是最常见的肌肉选择方法,85.2% 的受访者表示 "总是或几乎总是 "依靠这种方法。核磁共振成像和肌电图也经常用于肌肉选择(分别占 51.9% 和 45.4%)。在某些临床情况下,如出现肌炎特异性抗体或皮肌炎的皮肤表现时,肌肉活检的实用性存在差异。虽然受访者普遍报告肌肉活检后的并发症发生率较低,但无论采用哪种手术方法,非诊断性组织病理学结果都很常见。该专家组在活检适应症、手术方法和肌肉选择策略方面存在很大差异。随着 IIM 血清学分析技术的不断进步,今后需要开展研究,以确立最佳实践,并确定肌肉活检的作用。
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来源期刊
CiteScore
9.20
自引率
4.00%
发文量
176
审稿时长
46 days
期刊介绍: Seminars in Arthritis and Rheumatism provides access to the highest-quality clinical, therapeutic and translational research about arthritis, rheumatology and musculoskeletal disorders that affect the joints and connective tissue. Each bimonthly issue includes articles giving you the latest diagnostic criteria, consensus statements, systematic reviews and meta-analyses as well as clinical and translational research studies. Read this journal for the latest groundbreaking research and to gain insights from scientists and clinicians on the management and treatment of musculoskeletal and autoimmune rheumatologic diseases. The journal is of interest to rheumatologists, orthopedic surgeons, internal medicine physicians, immunologists and specialists in bone and mineral metabolism.
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