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Corneal confocal microscopy in small and mixed fiber neuropathy—Comparison with skin biopsy and cold detection in a large prospective cohort: Comparison with skin biopsy and cold detection in a large prospective cohort

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Název: Corneal confocal microscopy in small and mixed fiber neuropathy—Comparison with skin biopsy and cold detection in a large prospective cohort: Comparison with skin biopsy and cold detection in a large prospective cohort
Autoři: Asger Bjørnkær, Laura M. Gaist, Jakob V. Holbech, David Gaist, Martin Wirenfeldt, Søren H. Sindrup, Thomas Krøigård
Zdroj: Journal of the Peripheral Nervous System. 28:664-676
Informace o vydavateli: Wiley, 2023.
Rok vydání: 2023
Témata: Skin/pathology, Microscopy, Microscopy, Confocal, Cornea/diagnostic imaging, Biopsy, Small Fiber Neuropathy, quantitative sensory testing, Peripheral Nervous System Diseases/diagnostic imaging, Small Fiber Neuropathy/diagnosis, Peripheral Nervous System Diseases, 3. Good health, Cornea, Confocal/methods, corneal confocal microscopy, Humans, polyneuropathy, Prospective Studies, 10. No inequality, skin biopsy, Skin
Popis: Background and AimsThe diagnosis of small fiber neuropathy (SFN) is supported by reduced intraepidermal nerve fiber density (IENFD). The noninvasive method corneal confocal microscopy (CCM) has the potential to be a practical alternative. We aimed to estimate the diagnostic accuracy of CCM compared with IENFD and cold detection thresholds (CDT) in SFN and mixed fiber neuropathy (MFN).MethodsCCM was performed in an unselected prospective cohort of patients with a clinical suspicion of polyneuropathy. Predefined criteria were used to classify SFN and MFN. Neuropathy scores, including the Utah early neuropathy scale (UENS), were used to describe severity. Patients with established other diagnoses were used for diagnostic specificity calculations.ResultsData were taken from 680 patients, of which 244 had SFN or MFN. There was no significant difference in sensitivities [95%CI] of CCM (0.44 [0.38–0.51]), IEFND (0.43 [0.36–0.49]), and CDT (0.34 [0.29–0.41]). CCM specificity (0.75 [0.69–0.81]) was lower (p = .044) than for IENFD (0.99 [0.96–1.00]) but not than for CDT (0.81 [0.75–0.86]). The AUCs of the ROC curves of 0.63, 0.63 and 0.74 respectively, was lower for corneal nerve fiber density (p = .0012) and corneal nerve fiber length (p = .0015) compared with IENFD. While UENS correlated significantly with IENFD (p = .0016; R2 = .041) and CDT (p = .0002; R2 = .056), it did not correlate with CCM measures.InterpretationThe diagnostic utility of CCM in SNF and MFN is limited by the low specificity compared with skin biopsy. Further, CCM is less suitable than skin biopsy and CDT as a marker for neuropathy severity.
Druh dokumentu: Article
Jazyk: English
ISSN: 1529-8027
1085-9489
DOI: 10.1111/jns.12595
Přístupová URL adresa: https://pubmed.ncbi.nlm.nih.gov/37651181
https://portal.findresearcher.sdu.dk/da/publications/d0e107bd-1b8b-47e5-8be6-424c377565a1
https://doi.org/10.1111/jns.12595
Rights: CC BY NC ND
Přístupové číslo: edsair.doi.dedup.....ebf4f05ab3652cf5fec90785d6025321
Databáze: OpenAIRE
Popis
Abstrakt:Background and AimsThe diagnosis of small fiber neuropathy (SFN) is supported by reduced intraepidermal nerve fiber density (IENFD). The noninvasive method corneal confocal microscopy (CCM) has the potential to be a practical alternative. We aimed to estimate the diagnostic accuracy of CCM compared with IENFD and cold detection thresholds (CDT) in SFN and mixed fiber neuropathy (MFN).MethodsCCM was performed in an unselected prospective cohort of patients with a clinical suspicion of polyneuropathy. Predefined criteria were used to classify SFN and MFN. Neuropathy scores, including the Utah early neuropathy scale (UENS), were used to describe severity. Patients with established other diagnoses were used for diagnostic specificity calculations.ResultsData were taken from 680 patients, of which 244 had SFN or MFN. There was no significant difference in sensitivities [95%CI] of CCM (0.44 [0.38–0.51]), IEFND (0.43 [0.36–0.49]), and CDT (0.34 [0.29–0.41]). CCM specificity (0.75 [0.69–0.81]) was lower (p = .044) than for IENFD (0.99 [0.96–1.00]) but not than for CDT (0.81 [0.75–0.86]). The AUCs of the ROC curves of 0.63, 0.63 and 0.74 respectively, was lower for corneal nerve fiber density (p = .0012) and corneal nerve fiber length (p = .0015) compared with IENFD. While UENS correlated significantly with IENFD (p = .0016; R2 = .041) and CDT (p = .0002; R2 = .056), it did not correlate with CCM measures.InterpretationThe diagnostic utility of CCM in SNF and MFN is limited by the low specificity compared with skin biopsy. Further, CCM is less suitable than skin biopsy and CDT as a marker for neuropathy severity.
ISSN:15298027
10859489
DOI:10.1111/jns.12595