An Evaluation of Muscle Biopsies in a Managed Care Organization

Saad, Jill Moore., An Evaluation of Muscle Biopsies in a Managed Care Organization. Master of Science (Biomedical Sciences), May 2001, 16 pp., 7 illustrations, Reference List, 17 titles. Objective: The goal of this study was to assess the use of the percutaneous muscle biopsy in diagnosing inflammatory muscle diseases and to examine the benefit of centralizing inflammatory myopathies under one department-rheumatology-within a large health maintenance organization. Methods: A retrospective review of 363 muscle biopsies and histopathology reports, spanning 25 years, formed the basis of this study. The databases used in this study were the medical record, an institutional rheumatology registry, and histopathology reports. Cytoarchitectural abnormalities, necrosis and regeneration formed the basis of muscle disease classification. The histopathology findings were interpreted against the patient’s clinical history, examination, and clinical tests to develop a final diagnosis. Results: Rheumatologists in this location performed two-thirds of the biopsies percutaneously using an intervertebral rongeur and surgeons performed one-third open biopsies. Over time open biopsies were phased out due to preference for the percutaneous method. The average age of all muscle biopsy patients was 45 (3 months to 88 years old) and 55% were male. Polymyositis was the most frequently identified myositis (62%), followed by dermatomyositis (19%), and inclusion body myositis (7%). Conclusion: The use of percutaneous muscle biopsies using an intervertebral rongeur is the method of choice because of convenience, quality of specimen, low morbidity, and limited discomfort. Centralizing inflammatory muscle diseases within one organization contributes to the efficiency and effectiveness of inflammatory muscle disease management.