Optimal length and usefulness of temporal artery biopsies in the diagnosis of giant cell arteritis: a 10-year retrospective review of medical records

Chu, Rong; Foster, Caylea; Ali, Mehboob; Chaba, Todd; Clifford, Alison; Mahr, Alfred; Soo, Jason; Tervaert, Jan Willem Cohen; Yacyshyn, Elaine

doi:10.1016/s2665-9913(20)30222-8

Cited by 15 publications

(9 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Yet there are also practical constraints on the routinely achievable TAB lengths (particularly in females), and the recommended TAB length must balance the risk of biopsy with the probability of a positive result. Importantly, we identified that a TAB length of at least 15 mm was optimum for the predictive performance of our model, a result which is supported by two prior studies (18,19). A high proportion of TAB lengths shorter than 15 mm may be characteristic of many studies, given that an overall mean length of 14.1 mm was estimated from a meta-analysis of 49 studies ( 4), but an increase to a minimum TAB length of 15 mm is realistic and achievable.…”

Section: Discussionsupporting

confidence: 84%

Diagnosis of giant cell arteritis by temporal artery biopsy is associated with biopsy length

et al. 2022

View full text Add to dashboard Cite

AimsTemporal artery biopsy (TAB) is a widely used method for establishing a diagnosis of Giant Cell Arteritis (GCA). The optimal TAB length for accurate histological GCA diagnosis has been suggested as 15 mm post-fixation (15–20 mm pre-fixation). The aim of this study was to determine the relationship between a histological GCA diagnosis and optimal TAB length in the South Australian (SA) population.Materials and methodsPre-fixation TAB length (mm) was reported in 825/859 of all samples submitted to SA Pathology between 2014 and 2020 from people aged 50 and over. When more than one biopsy was taken, the longest length was recorded. Analyses of both TAB length and TAB positive proportions were performed by multivariable linear and logistic regression analysis, including covariates sex, age, and calendar year.ResultsThe median age of participants was 72 (IQR 65, 79) years, 549 (66%) were female. The TAB positive proportion was 172/825 (21%) with a median biopsy length of 14 mm (IQR 9, 18). Biopsy length (mm) was shorter in females (p = 0.001), increased with age (p = 0.006), and a small positive linear trend with calendar year was observed (p = 0.015). The TAB positive proportion was related to older age (slope/decade: 6, 95% CI 3.6, 8.3, p < 0.001) and to TAB length (slope/mm 0.6, 95% CI 0.2, 0.9, p = 0.002), but not sex or calendar year. Comparison of models with TAB length cut-points at 5, 10, 15, 20 mm in terms of diagnostic yield, receiver operating characteristics and Akaike Information Criteria confirmed ≥ 15 mm as an appropriate, recommended TAB length. However, only 383 (46%) of the biopsies in our study met this criteria. The diagnostic yield at this cut-point was estimated as 25% which equates to an expected additional 30 histologically diagnosed GCA patients.ConclusionThis study confirms that TAB biopsy length is a determinant of a histological diagnosis of temporal arteritis, and confirms that a TAB length ≥ 15 mm is optimal. Approximately half the biopsies in this study were shorter than this optimal length, which has likely led to under-diagnosis of biopsy-proven GCA in SA. Further work is needed to ensure appropriate TAB biopsy length.

show abstract

Section: Discussionsupporting

confidence: 84%

Diagnosis of giant cell arteritis by temporal artery biopsy is associated with biopsy length

et al. 2022

View full text Add to dashboard Cite

show abstract

“…A TAB-result was linked to a shorter steroid treatment duration; however, more than half (57.4%) of TAB-patients remained on steroids long term, reflecting the hesitancy of physicians to rely on a TAB-result. Similarly, other groups found that up to 87% 17,19 of TAB-patients were kept on long-term steroids.…”

Section: Receiving Prebiopsy Steroids Did Not Correlate To Tab Resultsmentioning

confidence: 66%

“…The presence of skip lesions might explain the reported low TAB positivity rate 18 ; however, the average biopsy specimen length in our study was within the recommended range of 1.5–2.0 cm. 19…”

Section: Discussionmentioning

confidence: 99%

Temporal Artery Biopsy Debate: Positive TAB Result Prolongs Steroid Use in Giant Cell Arteritis

Ponich

Lafrenière

Hartley

et al. 2022

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

Background: Temporal artery biopsy (TAB) in diagnosing giant cell arteritis has been criticized due to surgical risks, a high false negative rate, and redundant information when patients already met American College of Rheumatology criteria. The objective of this study was to investigate TAB's impact on steroid treatment duration. Methods: A retrospective chart review garnered patient demographics, symptoms, comorbidities, and steroid treatment duration in patients undergoing TAB at a single center. Steroid treatment was compared between TAB+ and TAB - patients. Results: One hundred seven patients undergoing TAB were included. Patients were predominantly women (70.1%) with a median age of 74 years (46 -91). Of 107 TAB results, 74 (69.2%) were negative, 23 (21.5%) were positive, and 10 (9.3%) were found to be indeterminate. In TAB+ patients, the mean erythrocyte sedimentation rate was not significantly different than TAB - patients (60.2 versus 43.7, P = 0.45), nor was the median C-reactive protein (38.8 versus 18.1, P = 0.17). Regarding steroid use, both TAB+ and TAB - patients had a similarly high rate of prebiopsy steroid initiation (82.6% versus 70.3%, P = 0.32). More TAB+ patients remained on steroids at 6 weeks (95.0% versus 57.4%, P = 0.004), 6 months (95% versus 37.7%, P < 0.001), 1 year (65.0% versus 31.1%, P = 0.024), and 18 months (50.0% versus 19.7%, P = 0.045). By 2 years, the difference no longer met significance (35.0% versus 14.8%, P = 0.12). P = 0.12). Conclusion: TAB positivity does seem to influence maintenance of steroids up to 18 months after biopsy.

show abstract

“…Chu et al suggested an optimal biopsy pre-fixation length of 1.5–2.0 cm to diagnose patients with giant cell arteritis based on the analysis of 1190 temporal artery biopsies from 1163 patients. 26 However, a recent study by Muratore et al found that a postfixation temporal artery biopsy specimen length of at least 5 mm, corresponding to a prefixation surgical specimen length of 7–10 mm, maximizes the diagnostic accuracy of temporal artery biopsy. 27 They also reported that, in order not to miss inflammation limited to adventitial and/or periadventitial small vessels as described above, at least three other sections at deeper levels should be evaluated in all uninflamed temporal artery biopsy specimens.…”

Section: Temporal Artery Biopsymentioning

confidence: 99%

Diagnostic Approaches for Large Vessel Vasculitides

Betrains¹,

Blockmans²

2021

OARRR

View full text Add to dashboard Cite

The large vessel vasculitides comprise giant cell arteritis (GCA), Takayasu arteritis (TAK), and chronic periaortitis. The diagnostic approach to these conditions involves the correct use and interpretation of clinical criteria, imaging techniques, and, in case of GCA, temporal artery biopsy. Ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT) reveal a homogeneous, concentric, thickening of the arterial wall. MRI and CT may also reveal aneurysms and stenoses. 18F-Fluorodeoxyglucose (FDG)-PET shows increased FDG uptake of inflamed artery walls delineating increased metabolic activity. Ultrasound, FDG-PET, and MRI are the recommended imaging techniques in GCA and TAK. In patients with a high suspicion of GCA who present with visual disturbances, initiation of high-dose intravenous corticosteroids should not be delayed by imaging. Extracranial large vessel vasculitis may be confirmed by all three modalities, particularly by FDG-PET in case of atypical clinical pictures. In this article, we review the role of the GCA and TAK ACR classification criteria, temporal artery biopsy, conventional angiography, ultrasound, MRI, magnetic resonance angiography (MRA), CT angiography (CTA), and FDG-PET in the diagnostic approach of large vessel vasculitis.

show abstract

Optimal length and usefulness of temporal artery biopsies in the diagnosis of giant cell arteritis: a 10-year retrospective review of medical records

Cited by 15 publications

References 19 publications

Diagnosis of giant cell arteritis by temporal artery biopsy is associated with biopsy length

Diagnosis of giant cell arteritis by temporal artery biopsy is associated with biopsy length

Temporal Artery Biopsy Debate: Positive TAB Result Prolongs Steroid Use in Giant Cell Arteritis

Diagnostic Approaches for Large Vessel Vasculitides

Contact Info

Product

Resources

About