We enjoyed reading Dr. Magistris and colleagues' report on needle muscle biopsy. 3 We perform the majority of our adult muscle biopsies in the fashion described by Cote ´et al., 2 and we agree that this technique is very convenient, safe, and useful. 1 The ability to procure adequate tissue for muscle culture is another important use of this method identified by the authors.
We also agree that dedicated and skilled assistance from histopathology colleagues is a requirement. There are three other advantages of this method that warrant mention. One is the ability to easily perform muscle biopsies at the patient's bedside. This is particularly useful in critically ill patients who can only be transported to the operating suite with risk or great difficulty. Second, in contrast to Dr. Magistris and colleagues, we find the skin incision to be unnecessary. The point of the biopsy needle can adequately penetrate the skin and fascia with little discomfort and the small hole closes up without need for sutures or surgical strips. Third, needle muscle biopsy is much less expensive than open biopsy. In addition, we have performed electron microscopy on many specimens and have achieved very good results. Inability to fix the length of specimens does induce some mild artifactual waviness, but most ultrastructural abnormalities are readily identified.
We have observed that the yield of this method can be improved with proper patient and biopsy site selection. In experienced hands, such as those of Magistris et al., the advantages of this procedure are noteworthy. Although we still prefer open biopsy for assessment of potentially inherited metabolic myopathies, unless DNA diagnosis is available, such demonstrable advantages warrant the attention of physicians (particularly in North America) who have been reluctant to accept this technique in favor of open biopsy.