Temporal artery biopsy in the diagnosis of giant cell arteritis: Bigger is not always better

Papadakis, Marios; Kaptanis, Sarantos; Kokkori-Steinbrecher, Aikaterini; Floros, Nikolaos; Schuster, Frauke; Hübner, Gunnar

doi:10.1016/j.amjsurg.2017.08.020

Cited by 18 publications

(23 citation statements)

References 14 publications

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“…There was no difference in postfixation TAB specimen length between TAB specimens positive and negative for GCA. Our data are concordant with 3 previous studies that reported comparable biopsy sample lengths in positive and negative TAB specimens (13,17,18). However, 4 other studies reported longer biopsy sample lengths in TAB specimens positive for GCA compared with negative TAB specimens (Table 3) (12,14,15,19).…”

Section: Discussionsupporting

confidence: 93%

Association Between Specimen Length and Number of Sections and Diagnostic Yield of Temporal Artery Biopsy for Giant Cell Arteritis

Muratore

Boiardi

Cavazza

et al. 2021

Arthritis Care & Research

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Objective To investigate the association between specimen length and number of sections evaluated and the diagnostic yield of temporal artery biopsy (TAB) for giant cell arteritis (GCA). Methods A pathologist reviewed all TABs performed for suspected GCA between January 1991 and December 2012. The blocks of all the inadequate and negative biopsy specimens were recut, and further slides at deeper levels were stained with hematoxylin and eosin in order to avoid missing inflammatory changes. Results In total, findings from 662 TABs were included in the study (71% female; mean age 73.2 years). A total of 427 TAB specimens (65%) were classified as negative, and 235 (35%) were classified as positive for GCA. Compared to those with negative TAB results, patients with positive TAB results were older and more frequently female. There was no difference in postfixation TAB specimen length between TAB specimens negative and positive for GCA (mean 6.5 mm versus 6.9 mm; P = 0.068). Cuts of additional biopsy sections revealed inflammation at deeper levels in 26 of 408 TAB specimens (6.4%) originally reported as uninflamed. The inflamed section was the second in 14 TAB specimens, the third in 9 specimens, and the fourth in 3 specimens. Piecewise logistic regression identified 5 mm as the TAB specimen length change point for diagnostic sensitivity. Compared to a TAB specimen length of <5 mm, the age‐ and sex‐adjusted odds ratio for positive TAB results in samples ≥5 mm long was 1.5 (95% confidence interval 1.0–2.0), P = 0.032. Conclusion A postfixation TAB specimen length of at least 5 mm should be sufficient to make a histologic diagnosis of GCA. In order not to miss inflammatory changes, at least 3 further sections at deeper levels should be evaluated in all negative TAB specimens.

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Section: Discussionsupporting

confidence: 93%

Association Between Specimen Length and Number of Sections and Diagnostic Yield of Temporal Artery Biopsy for Giant Cell Arteritis

Muratore

Boiardi

Cavazza

et al. 2021

Arthritis Care & Research

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“…Allison et al [23] Taylor-Gjevre et al [27] 2005 Canada Retrospective review 141 141 17. 6 27 More positive results at post-fixation length of 10 mm Arashvand et al [28] [29] 2007 Australia Retrospective observational study 157 157 11.85 N/S Specimens of ≥ 20 mm were 2.8 times more likely to show features of GCA than those < 20 mm Breuer et al [31] 2009 Israel Retrospective review [34] 2016 Israel Retrospective analysis 240 240 10.7 ± 5.7 25.83 Length of biopsy is not a determining factor Gajree et al [35] 2017 Scotland Retrospective analysis 715 715 11.64 ± 6.4 35 Length of specimen does not necessarily change the likelihood of a positive biopsy Papadakis et al [36] 2017 Germany Retrospective analysis 116 116 9.4 55.2 TAB length is not associated with the TAB diagnostic yield in patients with clinical suspicion of GCA Table 4. Continued.…”

Section: Main Finding and Conclusionmentioning

confidence: 99%

Temporal Artery Biopsy for Diagnosing Giant Cell Arteritis: A Ten-year Review

Aghdam

Sanjari

Manafi

et al. 2020

JOVR

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Purpose: To assess the use of temporal artery biopsy (TAB) in diagnosing giant cell arteritis (GCA) and to evaluate patients’ clinical and laboratory characteristics. Methods: We conducted a retrospective chart review of patients with suspected GCA who underwent TAB and had complete workup in a tertiary center in Iran between 2008 and 2017. The 2016 American College of Rheumatology (ACR) revised criteria for early diagnosis of GCA were used for each patient for inclusion in this study. Results: The mean age of the 114 patients in this study was 65.54 ± 10.17 years. The mean overall score according to the 2016 ACR revised criteria was 4.17 ± 1.39, with 5.82 ± 1.28 for positive biopsies and 3.88 ± 1.19 for negative biopsies (p <0.001). Seventeen patients (14.9%) had a positive biopsy. Although the mean post-fixation specimen length in the biopsy-positive group (18.35 ± 6.9 mm) was longer than that in the biopsy-negative group (15.62 ± 8.4 mm), the difference was not statistically significant (P = 0.21). There was no statistically significant difference between the groups in terms of sex, serum hemoglobin, platelet count, and erythrocyte sedimentation rate. There were statistically significant differences between the biopsy-negative and biopsy-positive groups with respect to patients’ age and C-reactive protein level (P < 001 and P = 0.012, respectively). Conclusion: The majority of TABs were negative. Reducing the number of redundant biopsies is necessary to decrease workload and use of medical services. We suggest that the diagnosis of GCA should be dependent on clinical suspicion.

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“…Mahr et al reported that a xed TAB specimen length of at least 0.5 cm may be su cient for histopathological diagnosis of GCA [11]. In the diagnosis of GCA, it is also thought that the length of the TAB specimens does not have an important impact on positivity [11,20,21]. In 80% of our patients, the time for TAB administration was before the treatment or within the rst 7 days after the initiation of the treatment.…”

Section: Discussionmentioning

confidence: 76%

Giant Cell (Temporal) Arteritis: The Rate and Clinical Predictors of Histopathological Diagnosis

Yücel

Gün

et al. 2021

Preprint

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Purpose To determine the rate of histopathological diagnosis by temporal artery (TA) biopsy (TAB) and the predictive clinical features of TAB positivity in patients with giant cell arteritis (GCA). Methods The records of patients who underwent TAB with pre-diagnosis of GCA between January 2006 and May 2020 were retrospectively reviewed. The demographic characteristics, symptoms, clinical and laboratory findings, TAB data, and the medications of the patients were recorded. The patients were divided into two groups as TAB-negative and TAB-positive, and compared clinically. Factors affecting TAB positivity were determined. Results TAB confirmed the diagnosis of GCA in 48% of our cases. The median fixed TAB specimen length was 1.7 (0.5–4.0) mm. TAB positivity increased with age (74 vs. 66 years, p = 0.027) and was more common in women (91.7% vs. 38.5%, p = 0.019). Jaw claudication (66.7% vs. 15.4%, p = 0.027) and decreased pulse of the TA (58.3% vs. 7.7%, p = 0.022) were more in the TAB-positive group than in the TAB-negative. The median C-reactive protein (CRP) level was statistically higher in the TAB-positive group compared to the TAB-negative (37 mg/L vs. 12.6 mg/L, p = 0.039). The univariate logistic regression analysis revealed female gender [OR (95%CI): 2.9 (1.7-181.3), p = 0.016], presence of jaw claudication [OR (95%CI): 2.4 (1.6–75.5), p = 0.015], decreased TA pulse [OR (95%CI): 2.8 (1.6-174.5), p = 0.018], and erythrocyte sedimentation rate (ESR) [OR (95%CI): 0.03 (1.0-1.1), p = 0.049] as factors associated with TAB positivity. Conclusion The rate of TAB positivity was 48%. Older age, female gender, the presence of jaw claudication and decreased pulse of TA, high ESR and CRP values are predictive features of TAB positivity and GCA diagnosis.

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Temporal artery biopsy in the diagnosis of giant cell arteritis: Bigger is not always better

Cited by 18 publications

References 14 publications

Association Between Specimen Length and Number of Sections and Diagnostic Yield of Temporal Artery Biopsy for Giant Cell Arteritis

Association Between Specimen Length and Number of Sections and Diagnostic Yield of Temporal Artery Biopsy for Giant Cell Arteritis

Temporal Artery Biopsy for Diagnosing Giant Cell Arteritis: A Ten-year Review

Giant Cell (Temporal) Arteritis: The Rate and Clinical Predictors of Histopathological Diagnosis

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