A study of temporal artery biopsy for the diagnosis of giant cell arteritis

Butendieck, Ronald R.; Calamia, Kenneth; Sandin, Adam

doi:10.1007/s10067-022-06371-0

Cited by 7 publications

(4 citation statements)

References 29 publications

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“…“While the number of TAB-positive cases increased to 66.7% (from 33.3%) with >15 mm length segment, it was found to be not a statistically siginificant different in the mean length between TAB-positive and TAB-negative samples”. Nonetheless, these results are in keeping with recent data which highlight that a longer specimen length is not associated with a greater diagnostic yield [ 15 ]. The results depend more on adequate temporal artery histopathological sections and technical processing in the laboratory [ 16 ].…”

Section: Discussionsupporting

confidence: 90%

Distinguishing laboratory characteristics in giant cell arteritis: a real-world retrospective cohort study

Goel,

Usmani,

Bacchi

et al. 2023

Int Ophthalmol

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Background Untreated Giant Cell Arteritis (GCA) has the potential to cause serious complications such as vision loss. Appropriate initial assessment by General Practitioners, early treatment and specialist referral are therefore essential in reducing morbidity. However, lack of awareness around the range of presentations can lead to a delay in diagnosis. Objective We aim to evaluate the discriminative diagnostic performance of laboratory characteristics associated with GCA in our population over a period of 18 months. Discussion This is a real-world retrospective review of patients referred to ophthalmology services with concern for GCA. The pre-test probability of a patient referred with suspected GCA was 13.9% to have GCA, highlighting the need for specialist referrals to continue. White Cell Count (p = 0.01), Platelet Count (p = 0.02), Erythrocyte sedimentation rate (p = 0.004) and C-reactive protein (p = 0.002) were significantly different between GCA and non-GCA cases. Moreover, this study demonstrates that absolute neutrophil count (p = 0.02) can be a useful parameter in initial investigations for GCA.

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Section: Discussionsupporting

confidence: 90%

Distinguishing laboratory characteristics in giant cell arteritis: a real-world retrospective cohort study

Goel,

Usmani,

Bacchi

et al. 2023

Int Ophthalmol

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“…Biopsy length was uniformly noted to have no significant effect on biopsy positivity. Of the 603 patients with bilateral biopsy, 43 (7%) had a negative initial biopsy followed by a positive result on the contralateral side [6].…”

Section: Main Clinical Findingsmentioning

confidence: 99%

Clinical evidence and diagnosis of temporal arteritis: a concise systematic review

Liedtke¹,

Daher²,

Moura³

et al. 2023

MedNEXT

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Introduction: Temporal arteritis (TA), or giant cell arteritis, is a systemic autoimmune vasculitis that affects patients over 50 years of age. Temporal artery biopsy is considered the gold standard for diagnosis, although it has low sensitivity. It was shown that TA can lead to irreversible blindness in about 20% of untreated cases. Objective: A concise systematic review was carried out to contribute to the diagnosis and treatment of temporal arteritis, assessing whether a series of patients met the clinical and laboratory criteria for diagnosis, regardless of the biopsy result, as well as whether these results alter the management of these patients. Methods: The research was carried out from December 2022 to January 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, following the PRISMA rules for systematic review. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 140 articles were found, and a total of 32 articles were evaluated and 6 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 32 studies with a high risk of bias and 43 studies that did not meet GRADE. It was concluded that, regardless of the biopsy result, all patients should immediately start treatment with corticosteroids. Early diagnosis and treatment must be performed to avoid compromising the contralateral eye. In addition, it is necessary to perform other diagnostic imaging tools to increase the sensitivity and closure of the diagnosis of temporal arteritis.

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“…[ 32 ] A study with temporal artery biopsies over an 11-year period from Mayo Clinic also indicated that biopsy length was uniformly noted to have no significant effect on biopsy positivity. [ 33 ] The authors explained that the reasons may be due to rich clinical experience and bilateral TAB to increase the positive rate.…”

Section: Length Of the Specimenmentioning

confidence: 99%

“…[ 34 , 35 ] Butendieck examines 603 patients with a bilateral biopsy for the diagnosis of GCA in Mayo Clinic and found 7% patients had a negative initial biopsy followed by a positive result on the contralateral side. [ 33 ] Mehta reviewed 310 patients who underwent bilateral TAB and observed a 12.1% discordance rate between pathology results. [ 36 ] The discordance rates in TAB specimens suggest that performing a bilateral TAB offers additional clinical benefit, such as increasing the positive rate of TAB and reducing the missed diagnosis rate of GCA.…”

Section: Management Strategies For Tab-negative Patientsmentioning

confidence: 99%

Temporal artery biopsy for suspected giant cell arteritis: A mini review

Jiang,

Ji,

Dong

2023

Indian Journal of Ophthalmology

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Giant cell arteritis (GCA) is a granulomatous inflammation involving medium and large vessels that can lead to serious clinical manifestations associated with tissue ischemia. Temporal artery biopsy (TAB) is currently the gold standard method for the diagnosis of GCA, with a specificity of 100% and a sensitivity of 77%. However, the false-negative rate for TAB ranges from 9% to 61%. False negatives may be related to the timing of biopsy, the length of specimen, and the existence of “skip lesions.” We reviewed the relevant evidence for methods to improve the sensitivity and reduce the false-negative rate for TAB. To reduce the false-negative rate for TAB, it is recommended to perform TAB within 1 week of starting corticosteroid therapy. Although there is currently no consensus, we suggest that the temporal artery is cut to a length of 20‒30 mm and to prepare serial pathological sections. It is necessary to attach great importance to patients suspected of having GCA, and complete TAB should be performed as soon as possible while starting corticosteroid therapy promptly. We also discuss the clinical value of non-invasive vascular imaging technologies, such as DUS, CTA, MRA, and 18F-FDG-PET/CT, as auxiliary methods for GCA diagnosis that could partially replace TAB.

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A study of temporal artery biopsy for the diagnosis of giant cell arteritis

Cited by 7 publications

References 29 publications

Distinguishing laboratory characteristics in giant cell arteritis: a real-world retrospective cohort study

Distinguishing laboratory characteristics in giant cell arteritis: a real-world retrospective cohort study

Clinical evidence and diagnosis of temporal arteritis: a concise systematic review

Temporal artery biopsy for suspected giant cell arteritis: A mini review

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