{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T20:22:24Z","timestamp":1788466944545,"version":"build-2803163510"},"reference-count":35,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Muscle and Nerve"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Small fiber neuropathy (SFN) presents with neuropathic pain, dysesthesia, and autonomic symptoms in the context of normal nerve conduction studies, necessitating specialized diagnostic approaches. This evidence\u2010based review by the AANEM SFN Task Force evaluates the diagnostic utility of ancillary tests and appropriate screening laboratory investigations in the assessment of SFN. A comprehensive literature review was conducted using OVID MEDLINE and EMBASE from 1966 to January 2023. Studies were selected based on prespecified inclusion criteria requiring clinical symptoms consistent with SFN and normal large fiber conduction studies. Articles were independently reviewed and graded for evidence quality by multiple raters. Thirteen diagnostic and two laboratory screening studies met criteria. Skin punch biopsy assessing intraepidermal nerve fiber density showed Class II evidence (sensitivity 74%\u201378%, specificity 65%\u201380%). Additional metrics included intraepidermal fiber length and inter\u2010fiber distance. Corneal confocal microscopy (CCM) showed potential (Class III) but lacked validation in isolated SFN. Indirect tests (laser\/contact heat evoked potentials, cutaneous silent period) had variable sensitivity and high specificity. Lab screening identified metabolic\/immune etiologies in up to 64%, though most evidence was Class III. Skin biopsy is the most validated direct diagnostic tool for SFN, though CCM and indirect assessments can aid in diagnosis. No test offers enough sensitivity or specificity to serve as a stand\u2010alone gold standard. Despite limited high\u2010level evidence, screening for metabolic and immune conditions may help identify etiologies. Standardized methods and population studies are needed to improve accuracy.<\/jats:p>","DOI":"10.1002\/mus.70119","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T12:15:01Z","timestamp":1770812101000},"page":"952-960","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Diagnostic and Screening Laboratory Tests in the Assessment of Patients With Small Fiber Neuropathy: An Evidence\u2010Based Review\u2014Report of the American Association of Neuromuscular and Electrodiagnostic Medicine Small Fiber Neuropathy Task Force"],"prefix":"10.1002","volume":"73","author":[{"given":"Hans D.","family":"Katzberg","sequence":"first","affiliation":[{"name":"University Health Network and University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuen","family":"So","sequence":"additional","affiliation":[{"name":"Stanford Neuromuscular Research Stanford University  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Brannagan","sequence":"additional","affiliation":[{"name":"Columbia University Medical Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"England","sequence":"additional","affiliation":[{"name":"Louisiana State University Health Sciences Center  New Orleans Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Bromberg","sequence":"additional","affiliation":[{"name":"University of Utah  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"David","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital\/Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pushpa","family":"Narayanaswami","sequence":"additional","affiliation":[{"name":"Beth Israel Deaconess Medical Center\/Harvard Medical School (P.N.)  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