Association between specimen length and number of sections and diagnostic yield of temporal artery biopsy for giant cell arteritis

Temporal artery biopsy (TAB) is often recommended for patients suspected of having temporal arteritis. The sensitivity of TAB varies widely and is dependent upon a number of factors (e.g., number of biopsy specimens, corticosteroid pretreatment, specimen length). The purpose of this study was to determine the clinical utility of TAB in patients who are suspected of having giant cell arteritis (GCA). A retrospective review of patients who underwent TAB at Spectrum Health from January 1, 1998 to December 31, 2007 was performed. Forty-seven patients, ranging in age from 25 to 87 years (mean: 70.7 years), underwent 53 TABs. Females accounted for 72.3 per cent of the subjects. Positive biopsy results showing signs of GCA were obtained in 38.3 per cent of patients. Of patients who underwent biopsy, 78 per cent could have been excluded from the procedure based upon individual diagnostic criteria. Positive and negative biopsies had average lengths of 1.84 cm and 1.29 cm, respectively ( P < 0.05). In the community hospital setting, patients suspected of having GCA are frequently recommended to undergo unnecessary TAB. We advocate for more careful selection of patients to undergo this diagnostic surgical procedure. In cases where TAB is needed, we recommend a biopsy length of > 2 cm to increase the accuracy of diagnosis.

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OP0150 WHAT IS THE ROLE OF TEMPORAL ARTERY BIOPSY IN GIANT CELL ARTERITIS FAST-TRACK PATHWAYS WHEN TEMPORAL ARTERY ULTRASOUND IS NEGATIVE?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.6534 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 95.3-95

Author(s):

A. Sachdev ◽

S. Dubey ◽

C. Tiivas ◽

M. George ◽

P. Mehta

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Sensitivity And Specificity ◽

Fast Track ◽

Temporal Artery ◽

Clinical Findings ◽

Specimen Size ◽

Temporal Artery Biopsy ◽

Duration Of Treatment ◽

Relevant Role

Background:A number of centres are now running fast track pathways for diagnosis and management of Giant cell arteritis with ultrasound as the first port of call for diagnosis1. Temporal artery biopsies (TABs) have become the second line of investigation, and it is unclear how useful TAB is in this setting.Objectives:This study looked at accuracy of Temporal artery biopsy (TAB) in patients with suspected Giant Cell arteritis (GCA) with negative/inconclusive ultrasound (U/S) and how duration of treatment on steroids prior to these investigations and arterial specimen size affected it.Methods:Prospective study of all patients with suspected GCA referred for TAB when U/S was negative or inconclusive, as part of the local fast-track pathway (Coventry). Database included clinical findings, serological work up, U/S and TAB results and treatment. Sensitivity and specificity of U/S and TAB was calculated and compared based on duration of treatment with steroids.Results:One hundred and nine patients were referred for TAB via Coventry fast-track-pathway. The sensitivity of U/S in this cohort of patients was 9.08% and specificity was 93.33%. After 3 days of steroid this was 0% and 100% respectively. For TAB when done within 10 days of starting steroids, this was 65% and 87.5% respectively. After 20 days of steroids this was 0 % and 100%. The sensitivity and specificity was 20% and 85% when arterial specimen size was 11-15mm and 47% and 100% when specimen size was 16 mm or more. Sensitivity and specificity of U/S of 644 suspected GCA patients was 48% and 98%.Conclusion:Our study demonstrates that TAB plays a relevant role in GCA fast-track-pathways, when U/S is negative/inconclusive. TAB was more sensitive than U/S in this cohort of patients, but overall sensitivity of U/S was higher when calculated for all patients suspected with GCA. Both remain useful tests if performed early. TAB specimen size should ideally be 16mm or more and done within 10 days of starting steroids.References:[1]Jonathan Pinnell, Carl Tiivas, Kaushik Chaudhuri, Purnima Mehta, Shirish Dubey, O38 The diagnostic performance of ultrasound Doppler in a fast-track pathway for giant cell arteritis,Rheumatology, Volume 58, Issue Supplement_3, April 2019, kez105.036,https://doi.org/10.1093/rheumatology/kez105.036Disclosure of Interests:None declared

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Evaluating the Usefulness and Timing of the Temporal Artery Biopsy for the Diagnosis of Giant Cell Arteritis

The Laryngoscope ◽

10.1002/lary.22215 ◽

2011 ◽

Vol 121 (S5) ◽

pp. S264-S264

Author(s):

Stephen V. Tornabene ◽

Raymond Hilsinger ◽

Raul M. Cruz

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Temporal Artery ◽

Temporal Artery Biopsy

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AB0551 The impact of temporal artery biopsy on diagnosis of giant cell arteritis in clinical practice

10.1136/annrheumdis-2017-eular.4749 ◽

2017 ◽

Author(s):

E Kaltsonoudis ◽

D Kirochristos ◽

A Bai-Papoudou ◽

P Voulgari ◽

AA Drosos

Keyword(s):

Clinical Practice ◽

Giant Cell Arteritis ◽

Giant Cell ◽

Temporal Artery ◽

Temporal Artery Biopsy ◽

The Impact

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The sensitivity of temporal artery biopsy in the detection of giant cell arteritis is independent of tissue length

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqab191.055 ◽

2021 ◽

Vol 156 (Supplement_1) ◽

pp. S28-S29

Author(s):

H J Hurley ◽

P Q Deb

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Average Length ◽

Statistical Significance ◽

Temporal Artery ◽

Temporal Artery Biopsy ◽

Temporal Arteries ◽

Biopsy Specimens ◽

Two Samples ◽

Left And Right

Abstract Introduction/Objective Giant cell arteritis (GCA) is the most common vasculitis of the elderly, and the most common primary systemic vasculitis overall, with an annual incidence of 200/million. The long term sequelae, namely vision loss and stroke, are permanent and devastating. While GCA is often treated empirically based on clinical presentation, panarteritis on temporal artery biopsy is required for diagnosis. However, these biopsies have the tendency to be falsely negative due to skip lesions, a common feature of GCA. Therefore, we set out to determine whether longer biopsy specimens were more sensitive in the detection of GCA. Methods/Case Report A census of temporal artery biopsies performed with the indication of clinical symptoms of GCA was taken at our institution. The patient age, sex, biopsy laterality, biopsy length, and pathological diagnosis were recorded for each cataloged sample. Statistical significance of difference in biopsy length was tested using an unpaired t-test in R 4.1.0. Results (if a Case Study enter NA) A total of 114 temporal artery specimens were biopsied from 94 different patients with the indication of GCA and assigned a definitive positive or negative diagnosis. Of the 94 patients, 54 were female and 40 were male. Of the total pathological specimens, 11 were positive and 103 were negative. The overall average length of biopsy specimens was 2.13 cm with a standard deviation of 0.65 cm. The average positive biopsy was 2.26 cm long, and the average negative was 2.12 cm, an insignificant difference (0.14 cm, t = 0.7, p = 0.43). In 25 patients, biopsies were taken from both the left and right temporal arteries. Of those patients, 2 were positive for GCA and the remaining 23 were negative. Interestingly, the biopsy result in every case was identical between the left and right samples; we found no instances of pathological evidence of GCA in only one of the two samples from the same patient. Conclusion According to data taken at our institution, there is no indication to lengthen the biopsy requirements from the existing 1.5 cm. However, we have demonstrated evidence that it may be unnecessary to biopsy both temporal arteries in a single patient. Larger studies would be required to confirm our findings.

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THU0690 Retrospective analysis of temporal artery biopsy and its impact in the management of giant cell arteritis

10.1136/annrheumdis-2018-eular.4937 ◽

2018 ◽

Author(s):

G. Kasavkar ◽

A. sinha

Keyword(s):

Giant Cell Arteritis ◽

Retrospective Analysis ◽

Giant Cell ◽

Temporal Artery ◽

Temporal Artery Biopsy

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Full-field optical coherence tomography for the diagnosis of giant cell arteritis

10.1101/2020.05.21.108092 ◽

2020 ◽

Author(s):

Thomas Maldiney ◽

Hélène Greigert ◽

Laurent Martin ◽

Emilie Benoit ◽

Catherine Creuzot-Garcher ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Giant Cell Arteritis ◽

Giant Cell ◽

Temporal Artery ◽

Machine Intelligence ◽

Vasa Vasorum ◽

Temporal Artery Biopsy ◽

Optical Coherence ◽

Gabor Filtering ◽

Full Field

AbstractHistopathological examination of temporal artery biopsy (TAB) remains the gold standard for the diagnosis of giant cell arteritis (GCA) but is associated with essential limitations that emphasize the need for an upgraded pathological process. This study pioneered the use of full-field optical coherence tomography (FF-OCT) for rapid and automated on-site pathological diagnosis of GCA. Sixteen TABs (12 negative and 4 positive for GCA) were selected according to major histopathological criteria of GCA following hematoxylin-eosin-saffron-staining for subsequent acquisition with FF-OCT to compare structural modifications of the artery cell wall and thickness of each tunica. Gabor filtering of FF-OCT images was then used to compute TAB orientation maps and validate a potential automated analysis of TAB sections. FF-OCT allowed both qualitative and quantitative visualization of the main structures of the temporal artery wall, from the internal elastic lamina to the vasa vasorum and red blood cells, unveiling a significant correlation with conventional histology. FF-OCT imaging of GCA TABs revealed destruction of the media with distinct remodeling of the whole arterial wall into a denser reticular fibrous neo-intima, which is distinctive of GCA pathogenesis and accessible through automated Gabor filtering. Rapid on-site FF-OCT TAB acquisition makes it possible to identify some characteristic pathological lesions of GCA within a few minutes, paving the way for potential machine intelligence-based or even non-invasive diagnosis of GCA.

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The impact of Temporal Artery Biopsy for the diagnosis of Giant Cell Arteritis in clinical practice in a tertiary University Hospital

10.1101/512137 ◽

2019 ◽

Author(s):

E Kaltsonoudis ◽

E Pelechas ◽

A Papoudou-Bai ◽

E.T. Markatseli ◽

M Elisaf ◽

...

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Laboratory Data ◽

Unknown Origin ◽

Temporal Artery ◽

University Hospital ◽

Temporal Artery Biopsy ◽

Acute Phase Reactants ◽

Anemia Of Chronic Disease ◽

The Impact

ABSTRACTBackgroundTemporal artery biopsy (TAB) is useful in assisting with giant cell arteritis (GCA) diagnosis but lacks sensitivity. The aim of our study was to assess the diagnostic impact of TAB histology in patients with suspected GCA on hospital admission.MethodsA prospectively maintained database was queried for all TABs performed between 1-1-2000 until 31-12-2017 at the University Hospital of Ioannina. Thus, inclusion criteria were made on the grounds of every patient that underwent a TAB during the above-mentioned period, regardless of demographic, clinical and laboratory data.ResultsTwo hundred forty-five TABs were included (149 females and 96 males), with a mean age of 64.5 (±3.5) years. The mean symptoms duration until admission to the hospital was 8.6 (±1.3) weeks and all had elevated acute phase reactants on admission. The reasons of admission were fever of unknown origin (FUO) in 114 (46.5%) patients, symptoms of polymyalgia rheumatica (PMR) in 84 (34.3%), new headache in 33 (13.5%), anemia of chronic disease (ACD) in 8 (3.32%) and eye disturbances in 6 (2.5%) patients. Positive results were found in 49 (20%) TABs. More specifically, in 14% of patients with FUO, 21% in those with PMR, while in patients with a new headache the percentage was 27%. Finally, 5 out of 6 (83.3%) of patients with ocular symptoms and only one (12.5%) of those suffering from ACD. Visual manifestations and FUO are correlated with a positive TAB.ConclusionIt seems that TAB is useful in assisting with GCA diagnosis, but lacks sensitivity.

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