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Anatomic Pathology

Anatomic pathology is the study of organs and tissues to determine thecauses and effects of particular diseases.

While laboratory scientists typically analyze blood or other fluids from patients, anatomic pathology analyzes tissue specimens.

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An alternative method of testing

Epidermal Nerve Fiber Density (ENFD)
The Epidermal Nerve Fiber Density (ENFD) test is a highly sensitive and specific test for documenting small fiber peripheral neuropathy by quantifying and evaluating the integrity of the terminal branches of peripheral nerves within the epidermis.

A diminished number of small nerve fibers are indicative of established diseases; the lower the count, the more severe the disease state. Following the correct procedures, skin biopsy specimens can be collected remotely and sent to a specialized cutaneous nerve laboratory like Luxor. At this time, the test is performed by approximately five specialty laboratories in the U.S., that do not include the large national labs.

Associated Causes and Diagnoses:
  • Alcohol Abuse
  • Amyloidosis
  • Autoimmune Diseases
  • Celiac Disease
  • Complex RPS
  • Connective Tissue Disorders
  • Diabetes
  • Fabry’s Disease
  • Fibromyalgia
  • Guillain-Barre Syndrome
  • Lupus
  • Multiple Sclerosis
  • Parkinsons
  • Pharmacological & Neurotoxic Drug Exposure
  • Restless Leg Syndrome
  • Sarcoidosis
  • Sjorgen’s Syndrome
  • Vibratory Trauma
  • Vitamin B12 Deficiency
When should ENFD Testing be considered?

Per most insurance coverage policies, ENFD testing is generally indicated when:

  • Individual presents with symptoms of painful sensory neuropathy; AND
  • Physical examination shows no evidence of findings consistent with large-fiber neuropathy, such as reduced or absent muscle-stretch reflexes or reduced proprioception and vibration sensation; AND
  • There is no diagnosed history of a disorder known to predispose to painful neuropathy (e.g., diabetic neuropathy, toxic neuropathy, HIV neuropathy, celiac neuropathy, inherited neuropathy); AND
  • Electromyography and nerve-conduction studies are normal and show no evidence of large-fiber neuropathy
Advantages of ENFD Testing:
  • Quick 15 minutes or less procedure
  • Minimally invasive
  • In-Office Procedure
  • Mid-level provider (NP/PA) can collect specimen
  • Well defined procedure codes for the practice