156 Figure 1 Proposed new algorithm for diagnosing small fiber neuropathy (SFN) in sarcoidosis patients with symptoms and clinical signs suggestive of SFN. SFN = small fiber neuropathy; TTT NOAs = thermal threshold testing number of abnormalities This approach has two major advantages. First, an adjusted TTT protocol enables consulted neurologists to diagnose most of the patients with SFN themselves instead of referring to a specialized center. Consequently, it will decrease the number of patients referred to specialized centers where 50 µm skin biopsy testing is available and expectantly shorten the waiting list for the assessment of patients suspected of SFN with a normal TTT. According to our study, it will reduce the number of referrals with 65-90%9,43 to a center where 50 µm skin biopsy can be performed. Enhancing diagnostic accuracy is essential for timely and appropriate treatment, as SFN frequently occurs in patients with sarcoidosis and significantly impacts their quality of life. 10 163 10
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