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Oxford University Hospitals NHS Foundation Trust

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Neuropathology referrals

Updated 27 April 2015

(Please note: if you are operating from within OUH please follow visit the internal staff intranet for further information on muscle biopsies performed within the OUH.)

Diagnostic histopathology of muscle biopsies (non-OUH sites)

1) LIAISING WITH LOCAL CELLULAR PATHOLOGY SERVICE (for non-OUH sites)

Muscle biopsies routinely require tissue to be frozen very rapidly. If the biopsy is planned in your own hospital (away from OUH) we advise you to liaise closely with your local cellular pathology service in order to prepare the tissue optimally. They can contact us on 01865 234417 for advice on how to freeze samples optimally and how to arrange transport of the frozen tissue to our laboratory.

For a full list of hospitals which are routinely covered by our muscle diagnostic service please refer to Section 4 below.

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2) BOOKING A MUSCLE BIOPSY WITH OUR LABORATORY

Informing Neuropathology

Contact Neuropathology at least 24 hours prior to the biopsy being taken so we can advise and fax relevant information to you on precise sampling, handling and transport.

  • Please call laboratory staff: 01865 234417 Monday to Friday 8.30am - 4.30pm

Site of biopsy and clinical advice

Site should be based on the distribution of muscle weakness judged by clinical assessment.

For clinical advice on the best site to biopsy contact either:

  • Dr David Hilton-Jones: 01865 231854 (neurology, clinical lead for muscle diseases)*
  • Dr Monika Hofer: 01865 231697 (neuropathology, pathology lead for muscle diseases)
  • Dr Waney Squier: 01865 234932 (neuropathology)

Information required

  • (a) Date of the planned biopsy
  • (b) Patient details
  • (c) Investigations required
  • (d) Clinical contacts / bleeps in case we need to contact you
  • (e) Purchase order for billing

Tissue requirements

For information on (a) adequate sample size (b) how to send sample, please call laboratory staff:

  • Tel: 01865 234417

Some investigations require more tissue than others. To ensure an adequate sample is taken, call laboratory staff for advice. How the tissue sample is managed also depends on the investigations requested so please call in advance.

In general, muscle biopsies require tissue to be frozen and, therefore, the sample should be sent to the lab fresh (and NOT in formalin). Ideally, the sample should reach the laboratory as soon as possible for freezing. The laboratory will be able to advise in more detail on maximum acceptable transport times, which may depend on what tests are required as guided by the clinical context. In order to prevent the sample from drying out wrapping it in cling film or lightly dampened gauze may be helpful if a delay is anticipated.

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3) INFORMATION WHICH SHOULD ACCOMPANY THE MUSCLE SAMPLE

  • (a) Patient details, date and site of biopsy
  • (b) Clinical details**
  • (c) Investigations required
  • (d) Clinical contacts / bleeps in case we need to contact you

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4) ADDITIONAL INFORMATION

The muscle diagnostic service is offered routinely to the following hospitals:

  • Great Western (Swindon)
  • Royal Berkshire (Reading)
  • Kettering General
  • Birmingham Children's
  • Milton Keynes
  • Northampton General

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* If you are unsure whether a muscle biopsy would be of benefit in a particular clinical situation or if you would like management advice on a patient with complex neuromuscular problems which may or may not include a muscle biopsy we would recommend contacting Dr David Hilton-Jones (clinical lead for muscle diseases, Oxford Neuromuscular Centre) to discuss the case.

** In order to assess a muscle biopsy high quality clinical input is essential. The information should include symptoms / signs, their distribution and time course, relevant past medical history, relevant medications (e.g. is the patients on steroids or not), family history if relevant, creatine kinase (CK), neurophysiology results (if available), inflammatory markers / autoantibody profile (if appropriate) and a clinical differential diagnosis.

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