Diagnostic Performance of a Temporal Artery Biopsy for the Diagnosis of Giant Cell Arteritis in Japan-A Single-center Retrospective Cohort Study -

Abstract

Objectives To investigate the sensitivity and specificity of a temporal artery biopsy (TAB) in the diagnosis of giant cell arteritis (GCA) in a single-center retrospective cohort in Japan. Methods A retrospective chart review was performed on consecutive patients who visited our hospital between April 2009 and October 2018 and underwent a TAB. The sensitivity and specificity were calculated for the three pathological standards for a TAB, predetermined according to the pathological criterion of the 1990 American College of Rheumatology (ACR) criteria: A) vasculitis characterized by predominant mononuclear cell infiltration; B) vasculitis with granulomatous inflammation; and C) vasculitis with multinucleated giant cells. We also analyzed the clinical parameters predicting the diagnosis of GCA and the impact of a diagnostic delay of ≥3 months on cardiovascular complications of GCA. Results Our study population was 16 cases in the GCA group and 13 in the non-GCA group. The sensitivity and specificity for Standard A of a TAB were 81% and 85%, respectively, while those for stricter Standards B or C were identical, at 75% and 100%, respectively. These pathological standards, but not any other parameters, significantly predicted the diagnosis. A diagnostic delay tended to cause cardiovascular complications (p=0.057). Conclusion The sensitivity and specificity of the pathological standards of a TAB were favorable in our cohort and were the only predictors for the diagnosis of GCA. Considering the possible impact of a diagnostic delay on cardiovascular complications, the early recognition and prompt initiation of glucocorticoid therapy is needed, even in Japan, where GCA is uncommon.

Diagnostic Accuracy of Symptoms, Physical Signs, and Laboratory Tests for Giant Cell Arteritis

“…The clinical diagnosis was typically based on clinical and laboratory findings, imaging and/or TAB results, and a good initial response to glucocorticoid treatment (eTable 5 in the Supplement). In 16 of c Seven studies with the clinical diagnosis as the reference standard 46,68,71,[75][76][77]82 also allowed evaluation of TAB as the reference standard (558 patients). One study with the clinical diagnosis as the reference standard 68 also allowed evaluation of ultrasonography as the reference standard (23 patients).…”

“…16,33,37,46,51,61,64,69 n From 10 of the analyzed studies. 16,17,36,52,58,71,73,80,82,84 o From 8 of the analyzed studies. 16,17,39,58,73,80,84,87 p From 18 of the analyzed studies.…”

“…16,17,39,58,73,80,84,87 p From 18 of the analyzed studies. 16,24,25,34,36,39,43,54,58,61,69,71,73,79,80,82,84,87 q From 23 of the analyzed studies. 16,32,35,36,39,41,43,47-49,52,54,55,57,58,61,65,69,71,73,75,80,84 r From 15 of the analyzed studies.…”

“…16,35,36,43,47,52,55,57,58,61,69,73,75,80,84 s From 23 of the analyzed studies. 17,24,25,32-34,37,39,41, 46,48,49,53,58,60,[64][65][66]71,75,76,82,86 t From 4 of the analyzed studies. 16,32,54,79 u From 6 of the analyzed studies.…”

“…34,36,43,65,77 e From 8 of the analyzed studies. 24,25,34,35,63,71,73,82 f From 7 of the analyzed studies. 16,43,47,63,[71][72][73] g From 10 of the analyzed studies.…”