Value of temporal artery biopsy length in diagnosing giant cell arteritis

Oh, Lawrence; Wong, Eugene; Gill, Anthony J.; McCluskey, Peter; Smith, James E.

doi:10.1111/ans.13822

Cited by 35 publications

(29 citation statements)

References 30 publications

(66 reference statements)

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“…Due to the probability of the presence of skip lesions, particularly in cases with insufficient specimen size, falsenegative results (15-29%) may occur. [12] Ashton-Key and Gallagher found 10-61% false negativity and 6% false positivity in TABs due to arteriosclerosis as a result of aging and not the inflammatory process. [13] The ESR and CRP levels are biochemical markers that increase in GCA.…”

Section: Discussionmentioning

confidence: 97%

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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: Discussionmentioning

confidence: 97%

“…Oh et al [12] 2018 did not fulfill the ACR criteria (probably because 20% of the GCA patients have occult GCA). In contrast, 28.3% of the patients met the criteria but were biopsy negative.…”

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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“… 42 – 44 A review of 240 TABx found that specimen length was not associated with the diagnostic yield of TABx. 45 Others report fixed TABx length of 0.5 cm 26 (n=1,520 TABx), 0.7 cm (n=966 TABx), 27 or 1.5 cm 46 (n=538 TABx) as the possible optimum length threshold TABx length to predict GCA and avoid false negative TABx. There was no statistically significant difference in the lengths of TABx in the positive or negative biopsy groups in our study, 90% of which had a fixed length >1 cm in both groups.…”

Section: Discussionmentioning

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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“…[40][41][42] A recent retrospective study of 545 patients who underwent TABs found that having a minimum biopsy length of 15 mm increased the odds of a positive TAB by 2.25 times, and each millimeter increase in TAB length increased the odds of a positive TAB by 3.4%. 43 The odds of a positive TAB were 1.5 times greater with an ESR of at least 47 mm/hour, 5.3 times greater with a CRP of at least 2.45 mg/dL, and 4.2 times greater with a platelet count over 400,000/μL. 44 Color Doppler ultrasound (CDUS) has become increasingly popular among rheumatologists in the diagnosis of GCA.…”

Section: Diagnosis and Testingmentioning

confidence: 99%

Neuro-Ophthalmologic Complications of Giant Cell Arteritis: Diagnosis and Treatment

Fein

2019

Semin Neurol

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Giant cell arteritis (GCA) is the most common vasculitis in individuals 50 years or older, with a lifetime risk in the United States of 1% in women and 0.5% in men. It is a granulomatous disease that affects large- and medium-sized vessels, most notably the branches of the internal and external carotid arteries. GCA can cause both afferent and efferent visual manifestations, the most common being arteritic anterior ischemic optic neuropathy. Diagnosis of GCA is made using criteria developed by the American College of Rheumatology, which include clinical signs, positive biopsy, and elevated erythrocyte sedimentation rate. C-reactive protein and platelet counts may be elevated in GCA, and noninvasive imaging modalities such as Doppler ultrasound and magnetic resonance imaging are now being used to aid in diagnosis. While glucocorticoids are the mainstay of treatment for GCA, new breakthrough treatments such as tocilizumab (an anti-IL-6 receptor antibody) have shown great promise in causing disease remission and reducing the cumulative glucocorticoid dose. Emerging therapies such as abatacept and ustekinumab are still being studied and may be of use to clinicians in the future.

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Value of temporal artery biopsy length in diagnosing giant cell arteritis

Cited by 35 publications

References 30 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

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

Neuro-Ophthalmologic Complications of Giant Cell Arteritis: Diagnosis and Treatment

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