The Impact of Temporal Artery Biopsy at a UK Tertiary Plastic Surgery Unit

Abstract

Background: Guidelines recommend temporal artery biopsy (TAB) for patients suspected of having giant cell arteritis (GCA). We evaluated the impact of TAB on the diagnosis and management of patients with suspected GCA at a tertiary plastic surgery unit. Methods: A retrospective review of all TAB procedures performed at our centre over 7 years was performed. One hundred and one patients were included in the study. Patients were classified into 3 diagnostic groups: confirmed (positive TAB), presumed (negative TAB with high clinical suspicion) and unlikely (negative TAB with low clinical suspicion). The clinical presentation and management for each group were compared. Results: The average American College of Rheumatology (ACR) score was 3.07. The number of patients with an ACR score of ≥3 before TAB was 72 (71.3%) and remained the same after TAB. The number of patients who remained on steroid therapy was lower in the group with an unlikely diagnosis of GCA compared to the group with a confirmed diagnosis (p<0.05). Conversely, there was no significant difference in steroid therapy between those with a presumed and confirmed diagnosis (p>0.05). Conclusions: This study found a significant difference in steroid treatment between those with confirmed GCA and those where the diagnosis was unlikely showing that TAB may support decisions regarding steroid therapy. However, TAB was inappropriately requested for patients whose pre-TAB ACR score was ≥3 as this score is sufficient for the diagnosis of GCA. Therefore, the use of TAB should be limited to cases of diagnostic uncertainty.

Clinical pathways for patients with giant cell arteritis during the COVID-19 pandemic: an international perspective

“…We also found that reopening surgical services required arriving at a shared understanding of the role of temporal artery biopsies among everybody involved in making decisions on how to reopen services. The surgical literature might be interpreted as suggesting that giant cell arteritis can be diagnosed with the 1990 American College of Rheumatology (ACR) classification criteria, 13 , 14 , 15 , 16 , 17 a view that implies that a negative temporal artery biopsy has no diagnostic use, or that there is minimal value in doing a biopsy after a few weeks of steroid therapy because of false negatives. 15 In contrast, the rheumatology and ophthalmology literature suggests that the 1990 ACR classification criteria are not suitable for clinical diagnosis of giant cell arteritis.…”

Necessity of Temporal Artery Biopsy for Giant Cell Arteritis: A Systematic Review

“…Seven studies 11,12,14,15,17,19,20 reported on both positive and negative TAB prebiopsy steroid duration, and one study 13 reported on only the TAB+ group. Post-biopsy steroid commencement was specifically stated in seven studies, [10][11][12][13][14]16,18 with three studies 10,14,18 commenting on both TAB positive and negative groups.…”

“…In total, five studies commented on surgical complications. Four studies 15 , 16 , 18 , 20 reported on the wrong tissue being sampled, while Cristaudo et al 1 reported one facial nerve injury. There was no reporting on hematoma, wound healing complications, or alopecia.…”

“…Prebiopsy steroids were started in 257 (63%) of TAB− patients before biopsy, whereas 28 (8%) of patients who were not started on prebiopsy steroids [10][11][12]14,18 were started postbiopsy. Nine studies 1,10,[12][13][14][15][16]18,20 included postbiopsy information on TAB− patients and 145 (22%) of patients who received prebiopsy steroids had their treatment stopped postbiopsy.…”

“…After full-text review, 13 studies reporting on 1355 patients with suspected GCA were included in the systematic review. 1,[10][11][12][13][14][15][16][17][18][19][20][21] The first authors of eight studies were from surgical departments (general surgery, 1,[14][15][16]20 vascular surgery, 12,13 plastic surgery 18 ), and five from medical specialties (Rheumatology, 10,11,17 Internal Medicine, 21 Nuclear Medicine 19 ). Years of publication ranged from 1989 through 2019.…”