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Anatomic Pathology

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

We continue to expand our test offerings to better serve the growing needs of our clients and community. Our Anatomic Pathology department was established in 2022 with histology and cytology laboratories. We are one of few labs in our region to provide this class 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 Scientific. At this time, ENFD is performed by approximately five specialty laboratories in the U.S., not including 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

CINtec Plus

Luxor has been an early adopter of the dual-stain CINtec Plus cytology method, the only FDA approved triage test that has emerged as a way to more accurately predict the chance that a woman with positive HPV tests has precancerous cervical changes.

CINtec Plus uses dual biomarker technology to more accurately predict the chance that a woman with a positive HPV test has precancerous cervical changes, reducing the number of false positive results and substantially reducing referral to unnecessary colposcopy procedures.

Currently, women with positive HPV tests may have additional HPV tests or Pap cytology tests to assess the need for colposcopy, biopsy, or treatment. Pap cytology, in which specially trained laboratory professionals (cytotechnologists) analyze stained slides to look for abnormal cells, is used to find precancers before they progress to cancer. But these approaches are not ideal. For examples Pap cytology tests are time consuming, not very sensitive, and prone to false positive findings. HPV testing followed by dual-stain for primary cervical cancer screening is proposed as a more efficient alternative to HPV/Pap co-testing. Dual stain reduced referral to colposcopy by about a third compared with Pap (approximately 42% vs 60%).⁴ The test measures the presence of two proteins, p16 and Ki-67, cervical samples. Dual stain cytology showed good risk stratification for all HPV-positive women and for HPV-positive women with normal cytology.