Epidermal Nerve Fiber Density (ENFD)

Qualification and quantification of small fiber peripheral neuropathy utilizing immunohistochemistry and morphometric analysis

The Epidermal Nerve Fiber Density (ENFD) test is an objective method of documenting small fiber peripheral neuropathy by quantifying the terminal branches of peripheral nerves within the epidermis. The test is highly specific and sufficiently sensitive with 97% of accuracy rate. The test is recommended to perform when patients experience the following symptoms: pain and abnormal sensation (burning, prickling, shooting), as well as numbness, tightness, coldness in foot/ankle areas.

The common causes of small fiber peripheral neuropathy are: diabetes, types I & II; HIV; vibratory trauma; amyloidosis / monoclonal gammopathy; alcohol abuse; pharmacologic toxins (metronidazole); solvent exposure, and idiopathic neuropathy, when the cause can’t be determined, once thought to represent as much as half of all cases.

The ENFD test can also be used to predict the small nerve fiber peripheral neuropathy.

A small 3×3 mm skin biopsy is used for providing diagnostic information on small nerve fibers. The ENFD biopsy is superficial with a very low risk for infection. We provide doctors with the ENFD kit that contains everything necessary for performing the small surgery/skin biopsy, including Zamboni’s fixative, phosphate buffer and cryoprotectant.

Epidermal Nerve Fiber Density Analysis

  • Uses a simple 3 mm punch biopsy of skin
  • Objectively diagnose small fiber peripheral neuropathy
  • Establish qualitative and quantitative baselines
  • Predict the onset of neuropathy in person at risk
  • Monitor the therapeutic effect of surgical and medical treatment

Why entrust Bako with your ENFD testing?

  • We offer the most rapid turn-around time industry-wide
  • Our fixation reagents with extended shelf life for easier patient scheduling
  • Our reagents do not require a dedicated office refrigerator, as do others
  • Our fee schedule is roughly half that of our competitors

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The Most Experienced Lab to Provide Epidermal Nerve Fiber Density (ENFD) Testing

Bako ENFD testing service enables podiatrists to optimize the cost of care by minimizing subspecialist (neurology) over-referals, repeat testing and unecessary consultations while improving patient satisfaction

Request your complimentary BakoDx ENFD kits and in-service

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ENFD Helpful Information

Though we provide many services, we are pioneers in the development and use of epidermal nerve fiber density, a minimally invasive tool for the assessment of small fiber peripheral neuropathy. We will be honored to partner with you in the management of your neuropathic patients.

Download ENFD Procedure and Fixation Guide

Procedure for Shipping ENFD Specimen

Specimen Fixation / Rinse Procedure

  • Bako has provided Zamboni’s fixative (yellow fluid) for specimen fixation.
  • Your specimen MUST be placed in Zamboni’s for at least 8 hours, but because it is a weak acid, no more than 24 hours.
  • It is strongly recommended that ALL biopsies be placed in Zamboni’s overnight, and then rinsed first thing the following morning (procedure described below).
  • This rinse involves two simple steps; a bona-fide rinsing step and then emersion into cryoprotectant. The rinse takes only a minute.

Immediately After Biopsy

1. Place the 3mm punch biopsy in yellow fixative (labeled #1) for no less than 8 hours (it’s best to fix overnight), but no more than 24 hours. Refrigerate; DO NOT FREEZE!

The Following Morning

2. Pour off the Zamboni’s fixative, leaving the skin biopsy in its vial (pour into a dish to prevent losing the biopsy).
3. Refill biopsy tube with buffer rinse (labeled #2), to neutralize the Zamboni’s.
4. Pour off buffer rinse (into dish), again leaving skin biopsy in its original tube.
5. Repeat steps 3 and 4 using the remaining buffer rinse (labeled #2).
6. Lastly, fill the vial containing the biopsy with cryoprotectant (labeled #3) and screw the cap on TIGHTLY.
7. Ship to Bako in Styrofoam cooler (provided) using FedEx priority overnight (prepaid shipping labels provided with kit).
Biopsies left in Zamboni’s fixative must be shipped Mon-Fri. Tissue sent over weekends or holidays REQUIRE rinse and cryoprotection steps!

Download Specimen Shipping Guide

Request your complimentary BakoDx ENFD kits and in-service

Order now

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