Proposal to decrease the number of negative temporal artery biopsies

Abstract

Careful assessment of patients with clinically suspected GCA to rule out artery abnormalities, scalp tenderness, and jaw claudication can lead to a dramatic decrease in the percentage of negative biopsies. This observation may contribute to improving the physician's decision-making process when contemplating TAB.

Advances in the Diagnosis of Large Vessel Vasculitis

“…As a result, in a substantial proportion of patients TAB could be avoided. [15][16][17][18] Several investigators have analyzed clinical data associated with TAB results. The absence of manifest or subtle cranial symptoms or abnormalities at the careful temporal artery examination is associated with low probability of a positive TAB even in patients who really have GCA.…”

Vaskulitiden der großen Gefäße

“…Bei Sehstö-rungen darf der Therapiebeginn nicht für die Biopsie verzögert werden, auch wenn deren Aussagekraft unter Steroiden um 10-20% pro Woche abnimmt. Eine Temporalisbiopsie ist nicht sinnvoll, wenn lediglich Kopfschmerzen unklarer Ätiologie bei äl-teren Patienten vorliegen, die Ausbeute ist in diesen Fällen äußerst gering [21]. Eine positive Temporalisbiopsie lässt sich auch bei einem Teil der Patienten mit einer Polymyalgia rheumatica gewinnen.…”

Diagnosis and Treatment of Giant Cell Arteritis (Temporal Arteritis) – Past, Current and Future Aspects

“…Fiftynine negative biopsies would have been prevented, but six positive biopsies would have been missed (236). The findings jaw claudication, weight loss, pathological temporal artery enlargement, recent head-ache, and scalp tenderness have all been found to predict a positive biopsy (226,233,236,237). It is tentative to suggest that patients exhibiting none of these clinical features combined with a negative ultrasound should not be subjected to TAB before all other causes of current inflammatory manifestations are ruled out.…”

“…Consequently, predictive markers for a positive biopsy have long been searched for. In one study of TAB performed among patients suspected of having GCA, excluding patients with no evidence of temporal artery abnormalities, scalp tenderness, or jaw claudication, only 48% of the 125 biopsies would have been performed (236). Fiftynine negative biopsies would have been prevented, but six positive biopsies would have been missed (236).…”

“…In one study of TAB performed among patients suspected of having GCA, excluding patients with no evidence of temporal artery abnormalities, scalp tenderness, or jaw claudication, only 48% of the 125 biopsies would have been performed (236). Fiftynine negative biopsies would have been prevented, but six positive biopsies would have been missed (236). The findings jaw claudication, weight loss, pathological temporal artery enlargement, recent head-ache, and scalp tenderness have all been found to predict a positive biopsy (226,233,236,237).…”