That is true, but for a “gold standard” test, it has a very high margin of error so even for someone who has symptoms and a negative skin punch biopsy, it doesn’t necessarily change the diagnosis. It also doesn’t identify the cause. A negative EMG/NCS for me in the presence of sensory symptoms…still gave me a small fiber neuropathy diagnosis.

I did the biopsy because I was hoping for more certainty since otherwise small fiber sensory neuropathy is a clinical diagnosis (no objective test to “prove” it). Even if it was positive it would have been for my own peace of mind, sort of.

For my biopsy, one sample was “low normal” and the other was inconclusive because the sample didn’t have enough of whatever it is they need to count 🤷🏻‍♀️.

So…I walked away with two tiny scars (tiny, but I am darker skinned so have a tendency for more scarring), what was categorized as a negative test for small fiber neuropathy that didn’t rule it out, and the same diagnosis I started with, with the same treatment options I had before I did the biopsy.

Like with anything, there are pros and cons to weigh. For me it didn’t change anything when really what I wanted was treatment. I think sometimes doctors don’t explain the nuances well or put more emphasis on diagnoses but not treatment, especially for chronic conditions.

It’s noninvasive, usually covered by insurance, and not painful though, so it’s relatively low risk.