The impact of temporal artery biopsy on surgical practice

Cristaudo, Adam; Mizumoto, Ryo; Hendahewa, Rasika

doi:10.1016/j.amsu.2016.09.004

Cited by 19 publications

(30 citation statements)

References 24 publications

(42 reference statements)

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“…Temporal artery biopsy (TAB) is indicated for diagnosing suspected GCA cases. [8] Although the value of TAB has been recently disputed because of its high false-negative rates, it remains the gold standard for diagnosis. [9] The purpose of the current study was to investigate the use of TAB in diagnosing GCA at a tertiary center in Iran over a 10-year period.…”

Section: Introductionmentioning

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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Section: Introductionmentioning

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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“…This combined with evidence that TAB in a small proportion of patients may not change the management of GCA may lead to a greater role for imaging modalities in combination with scoring systems such as the ACR classification for GCA [5].…”

Section: Introductionmentioning

confidence: 99%

Temporal artery biopsy in the diagnosis of giant cell arteritis: Does the end justify the means?

Bowling

Rait

Atkinson

et al. 2017

Annals of Medicine &Amp; Surgery

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BackgroundEarly temporal artery biopsy is recommended in all patients with suspected cranial GCA (Giant Cell Arteritis) by the BSR (British Society of Rheumatology) and BHPR (British Health Professionals in Rheumatology) guidelines. This should be performed within one week ideally.AimTo assess ACR (American College of Rheumatology) score at presentation and whether temporal artery biopsy result affects clinical management of the clinically suspected GCA patient.MethodCase records of all temporal artery biopsies performed within January 2012 until December 2014 were analysed for size and result of biopsy and this was correlated to clinical management following result.Results129 temporal arteries were biopsied with a total of 17 positive biopsy results. 10 biopsy samples were insufficient to confirm or refute GCA. 8 patients within the biopsies negative for GCA had their prednisolone therapy stopped. 5 patients had unknown follow up, with the remainder (89, 87.3%) of the patients continued prednisolone management for treatment of GCA for at least 6 weeks.ConclusionOverall 13.2% of our biopsies were positive for GCA and 87.3% of biopsy negative patients continued prednisolone therapy on clinical grounds. In the face of new diagnostic tests (high resolution MRI (Magnetic Resonance Imaging), colour duplex USS (Ultra Sound Scan) and PET (Positive Emission Topography) can we justify invasive surgery to all patients on histological grounds when the results may not alter management? Further investigation is needed directly comparing newer imaging modalities to histology.

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“… 2 Temporal artery biopsy (TABx) remains the gold standard in the diagnosis of GCA, but is an invasive, time-consuming test with suboptimal sensitivity. Numerous articles 3 – 7 incorporate the 1990 American College of Rheumatology (ACR) classification criteria for GCA 8 to guide the decision for TABx. However, the ACR criteria were not meant to be diagnostic criteria, 9 and without the TABx result, the ACR criteria only have a sensitivity of 29%.…”

Section: Introductionmentioning

confidence: 99%

Multivariate prediction model for suspected giant cell arteritis: development and validation

Ing¹,

Luna²,

Toren³

et al. 2017

OPTH

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PurposeTo develop and validate a diagnostic prediction model for patients with suspected giant cell arteritis (GCA).MethodsA retrospective review of records of consecutive adult patients undergoing temporal artery biopsy (TABx) for suspected GCA was conducted at seven university centers. The pathologic diagnosis was considered the final diagnosis. The predictor variables were age, gender, new onset headache, clinical temporal artery abnormality, jaw claudication, ischemic vision loss (VL), diplopia, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and platelet level. Multiple imputation was performed for missing data. Logistic regression was used to compare our models with the non-histologic American College of Rheumatology (ACR) GCA classification criteria. Internal validation was performed with 10-fold cross validation and bootstrap techniques. External validation was performed by geographic site.ResultsThere were 530 complete TABx records: 397 were negative and 133 positive for GCA. Age, jaw claudication, VL, platelets, and log CRP were statistically significant predictors of positive TABx, whereas ESR, gender, headache, and temporal artery abnormality were not. The parsimonious model had a cross-validated bootstrap area under the receiver operating characteristic curve (AUROC) of 0.810 (95% CI =0.766–0.854), geographic external validation AUROC’s in the range of 0.75–0.85, calibration pH–L of 0.812, sensitivity of 43.6%, and specificity of 95.2%, which outperformed the ACR criteria.ConclusionOur prediction rule with calculator and nomogram aids in the triage of patients with suspected GCA and may decrease the need for TABx in select low-score at-risk subjects. However, misclassification remains a concern.

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The impact of temporal artery biopsy on surgical practice

Cited by 19 publications

References 24 publications

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

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

Temporal artery biopsy in the diagnosis of giant cell arteritis: Does the end justify the means?

Multivariate prediction model for suspected giant cell arteritis: development and validation

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