Too few, too late. Temporal artery biopsy in cranial arteritis

Area of Science:

• Neurology
• Rheumatology
• Pathology

Background:

• Cranial arteritis, a form of large-vessel vasculitis, presents diagnostic challenges.
• Temporal artery biopsy is a key diagnostic tool, but its utilization and effectiveness vary.
• Delayed diagnosis can lead to severe complications, including irreversible vision loss.

Purpose of the Study:

• To evaluate the incidence, timing, and adequacy of temporal artery biopsies in patients with suspected cranial arteritis.
• To assess the correlation between biopsy results, clinical findings, and erythrocyte sedimentation rate (ESR).
• To analyze the impact of biopsy on diagnosis timing and complication rates.

Main Methods:

• Retrospective review of 66 patients diagnosed clinically with cranial arteritis.
• Analysis of temporal artery biopsy rates, positivity, adequacy, and timing relative to symptom onset.
• Comparison of complication rates between patients who underwent biopsy and those who did not.

Main Results:

• Only 36 patients had biopsies; 24 were positive, 8 negative, and 4 inadequate.
• Clinical abnormalities were present in 13/24 biopsy-positive and 5/8 biopsy-negative patients.
• Average diagnostic delay was 128 days (52 days excluding >6 month delays); "no biopsy" group averaged 60 days.
• Serious complications occurred in 15 patients; 11 in the "no biopsy" group vs. 4 in the biopsy group (p<0.05).

Conclusions:

• Diagnosis of cranial arteritis is frequently delayed.
• Earlier and more frequent temporal artery biopsies with meticulous technique are recommended.
• Timely biopsy may expedite diagnosis and reduce preventable complications.