Table 1.  
Results
Over a two year period, a cohort of 8 patients met criteria to undergo the ultrasound-guided muscle biopsy using a modified Bergström needle and suction technique.  These patient's underwent a total of 9 biopsies during this time.   Table 1. summarises the outcome of these. 
A retrospective review demonstrated that eight of  the nine samples were of satisfactory diagnostic quality and permitted histological analysis.  The one that non-diagnostic was inappropriately transported in formaldehyde following the biopsy.  The biopsy that was inappropriately processed  was successfully repeated.  Furthermore, all eight of the successful ultrasound-guided biopsies aided a diagnosis, either by directly supporting a specific diagnosis, or by excluding certain diagnosis. 
 
Patient feedback from the procedure was encouraging and no significant complications were reported.  Four patients had undergone a surgical biopsy previously.  Two of these preferred the ultrasound-guided biopsy to the surgical approach, while the remaining two did not specify.  No complications were reported from the nine biopsies.   When asked to rate their experience between 0-5, with 0 being extremely poor and 5 being excellent, four patients rated 4 or 5, one rated 3.  The others did not fill this part of the questionnaire.  
Furthermore, of the four patient's who had had a previous surgical biopsy that had been unsuccessful in establishing a diagnosis, an ultrasound guided biopsy was successful in aiding a diagnosis in all.  This is particularly well demonstrated in a case of a 55 year old patient with a history of myopathic weakness since his teenage years affecting all limbs and extra-ocular muscles.  The MRI of his muscles had shown marked atrophy and fatty infiltration (Figure 1) , making a viable muscle biopsy target difficult to select.  This was discussed with the neurosurgical team who did not feel they could reliably biopsy muscle.  He had  already undergone two surgical muscle biopsies over the preceding decade which had been non-diagnostic.  Therefore, he underwent a successful ultrasound guided muscle biopsy using the aforementioned technique.  This high quality biopsy has aided us in diagnosing an autophagic vacuolar myopathy that is suspected to be a new case of X-linked myopathy with excessive autophagy (XMEA). 
Patient # Previous Surgical Biopsy Complications Appropriate Sample Diagnostically helpful Diagnosis Feedback Available Patient Experience 0 (Extremely Poor) – 5 (Excellent) Preferred to surgical biopsy (if applicable) Additional Notes
1 Yes No Yes Yes Systemic Vasculitis Yes 5 Yes None
2 No No Yes Yes Jo-1/Ro 52 associated inflammatory myopathy Yes 3 N/A None
3 Yes No Yes Yes Autophagic Vacuolar Myopathy Yes 4 No response. None
4 No No No No Unspecified Myopathy Yes 4 N/A Biopsy transported in formaldehyde due to error
5 No No Yes Yes Possible LGMD No N/A N/A  
6 No No Yes Yes No definite muscle pathology No N/A N/A Anti-Ku +ve
7 No No Yes No Axial Myopathy No N/A N/A 2 samples taken from Quadricep and paraspinal muscle – Quadricep diagnostic, paraspinal was not
8 Yes No Yes Yes Sporadic late-onset nemaline rod myopathy Yes 5 Yes  
9 Yes No Yes Yes Anti-SRP +ve necrotising myopathy No N/A No response.