Is colour duplex sonography-guided temporal artery biopsy useful in the diagnosis of giant cell arteritis? A randomized study

Germanò, Giuseppe; Muratore, Francesco; Cimino, Luca; Gullo, Alberto Lo; Possemato, Niccolò; Macchioni, Pierluigi; Cavazza, Alberto; Pipitone, Nicolò; Boiardi, Luigi; Salvarani, Carlo

doi:10.1093/rheumatology/keu241

Cited by 63 publications

(38 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Therefore, temporal artery biopsy (TAB) still plays a role in the diagnostic work-up of suspected cranial GCA. Notably, guidance of TAB by preoperative CDUS did not improve the diagnostic accuracy in a randomized study [35].…”

Section: Cranial Giant Cell Arteritismentioning

confidence: 86%

Ultrasound imaging in the diagnosis of large vessel vasculitis

Czihal

Lottspeich

Hoffmann

2017

Vasa

View full text Add to dashboard Cite

Summary: Nowadays noninvasive vascular imaging has an important role in the diagnostic work-up of the large vessel vasculitides (LVV), most importantly giant cell arteritis (GCA) and Takayasu arteritis. Among the imaging modalities available, ultrasound (US) has several important advantages, including low costs, rapid and repetitive availability without exposure to radiation, and high spatial resolution for assessment of large and medium-sized arteries. Therefore, US can be regarded the fi rst line imaging method in suspected LVV. In patients with suspected GCA, US can replace temporal artery biopsy in certain clinical scenarios, and the application of US early in the diagnostic work-up of suspected GCA in specialized fast track clinics has been suggested to reduce the rate of visual ischaemic complications and associated costs. In other LVV such as Takayasu arteritis and chronic periaortitis, the diagnostic accuracy in comparison to other noninvasive imaging methods has not been formally tested but can be considered to be excellent. However, quality of US is highly dependent on the operator's experience, and assessment of the thoracic aorta which is frequently involved in GCA and TA is limited. The role of US in the followup of LVV under treatment is unclear. In view of the promising data supporting its value on the one hand and several uncertainties and controversies on the other hand, the present review article provides a comprehensive overview on current evidence for the application of US in the diagnosis and follow up of LVV. Recent multicentre study results and emerging trends such as the application of compression sonography in the diagnosis of GCA and the use of contrast enhanced ultrasound in disease activity assessment in Takayasu arteritis are discussed.

show abstract

Section: Cranial Giant Cell Arteritismentioning

confidence: 86%

Ultrasound imaging in the diagnosis of large vessel vasculitis

Czihal

Lottspeich

Hoffmann

2017

Vasa

View full text Add to dashboard Cite

show abstract

“…A combined approach that used ultrasound to try to identify the most appropriate site for biopsy had no effect on the sensitivity of detecting histological evidence of GCA. 62 …”

Section: Accuracy Of Temporal Artery Biopsy Versus Ultrasound or Othementioning

confidence: 99%

The Role of Ultrasound Compared to Biopsy of Temporal Arteries in the Diagnosis and Treatment of Giant Cell Arteritis (TABUL): a diagnostic accuracy and cost-effectiveness study

Luqmani

Lee

Singh

et al. 2016

Health Technol Assess

366

417

View full text Add to dashboard Cite

Background Giant cell arteritis (GCA) is a relatively common form of primary systemic vasculitis, which, if left untreated, can lead to permanent sight loss. We compared ultrasound as an alternative diagnostic test with temporal artery biopsy, which may be negative in 9–61% of true cases. Objective To compare the clinical effectiveness and cost-effectiveness of ultrasound with biopsy in diagnosing patients with suspected GCA. Design Prospective multicentre cohort study. Setting Secondary care. Participants A total of 381 patients referred with newly suspected GCA. Main outcome measures Sensitivity, specificity and cost-effectiveness of ultrasound compared with biopsy or ultrasound combined with biopsy for diagnosing GCA and interobserver reliability in interpreting scan or biopsy findings. Results We developed and implemented an ultrasound training programme for diagnosing suspected GCA. We recruited 430 patients with suspected GCA. We analysed 381 patients who underwent both ultrasound and biopsy within 10 days of starting treatment for suspected GCA and who attended a follow-up assessment (median age 71.1 years; 72% female). The sensitivity of biopsy was 39% [95% confidence interval (CI) 33% to 46%], which was significantly lower than previously reported and inferior to ultrasound (54%, 95% CI 48% to 60%); the specificity of biopsy (100%, 95% CI 97% to 100%) was superior to ultrasound (81%, 95% CI 73% to 88%). If we scanned all suspected patients and performed biopsies only on negative cases, sensitivity increased to 65% and specificity was maintained at 81%, reducing the need for biopsies by 43%. Strategies combining clinical judgement (clinician’s assessment at 2 weeks) with the tests showed sensitivity and specificity of 91% and 81%, respectively, for biopsy and 93% and 77%, respectively, for ultrasound; cost-effectiveness (incremental net monetary benefit) was £485 per patient in favour of ultrasound with both cost savings and a small health gain. Inter-rater analysis revealed moderate agreement among sonographers (intraclass correlation coefficient 0.61, 95% CI 0.48 to 0.75), similar to pathologists (0.62, 95% CI 0.49 to 0.76). Limitations There is no independent gold standard diagnosis for GCA. The reference diagnosis used to determine accuracy was based on classification criteria for GCA that include clinical features at presentation and biopsy results. Conclusion We have demonstrated the feasibility of providing training in ultrasound for the diagnosis of GCA. Our results indicate better sensitivity but poorer specificity of ultrasound compared with biopsy and suggest some scope for reducing the role of biopsy. The moderate interobserver agreement for both ultrasound and biopsy indicates scope for improving assessment and reporting of test results and challenges the assumption that a positive biopsy always represents GCA. Future work Further research should address the issue of an independent reference diagnosis, standards for interpreting and reporting test results and the evaluation of ultrasound training, and should also explore the acceptability of these new diagnostic strategies in GCA. Funding The National Institute for Health Research Health Technology Assessment programme.

show abstract

“…The diagnosis of LVV is often difficult, particularly in cases of nonspecific presentation such as fever, malaise, elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) and weight loss; moreover, clinical manifestations (if any) may be extremely variable, due to the isolated involvement of a specific arterial tract, with subsequent complications [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

The prognostic value of baseline 18F-FDG PET/CT in steroid-naïve large-vessel vasculitis: introduction of volume-based parameters

Dellavedova

Carletto

Faggioli

et al. 2015

Eur J Nucl Med Mol Imaging

View full text Add to dashboard Cite

show abstract

Is colour duplex sonography-guided temporal artery biopsy useful in the diagnosis of giant cell arteritis? A randomized study

Abstract: Our study showed that CDS-guided TAB did not improve the sensitivity of TAB for diagnosing GCA.

Cited by 63 publications

References 20 publications

Ultrasound imaging in the diagnosis of large vessel vasculitis

Ultrasound imaging in the diagnosis of large vessel vasculitis

The Role of Ultrasound Compared to Biopsy of Temporal Arteries in the Diagnosis and Treatment of Giant Cell Arteritis (TABUL): a diagnostic accuracy and cost-effectiveness study

The prognostic value of baseline 18F-FDG PET/CT in steroid-naïve large-vessel vasculitis: introduction of volume-based parameters

Contact Info

Product

Resources

About