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Effect of Temporal Artery Biopsy Length and Laterality on Diagnostic Yield
Alice Shen1, Anna M Gruener, Andrew R Carey
1USC Roski Eye Institute (AS, JRC), Keck School of Medicine of the University of Southern California, Los Angeles, California; Wilmer Eye Institute (AMG, ARC, ADH, TJM, JRC), Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Ophthalmology (AMG, AP), Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; School of Medicine (AMG), Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom; and Moorfields Eye Hospital (AP), London, United Kingdom.
Insights
Giant cell arteritis diagnosis via temporal artery biopsy (TAB) is standard. This study found biopsy length does not impact results, but bilateral TABs may slightly increase diagnostic yield by detecting discordant cases.
Area of Science:
- Ophthalmology
- Rheumatology
- Pathology
Background:
- Giant cell arteritis (GCA) is a prevalent vasculitis impacting adults, carrying substantial morbidity and mortality risks.
- Temporal artery biopsy (TAB) is the definitive diagnostic method in the U.S., though procedural variations exist regarding specimen length and laterality.
Purpose of the Study:
- To evaluate the association between temporal artery biopsy (TAB) length and diagnostic yield for giant cell arteritis (GCA).
- To assess the diagnostic utility of unilateral versus bilateral TABs in GCA detection.
Main Methods:
- A retrospective chart review was conducted on all TABs performed at the Johns Hopkins Wilmer Eye Institute from July 2007 to September 2017.
- Data from 586 patients undergoing TAB for suspected GCA were analyzed, comparing outcomes of unilateral and bilateral biopsies.
Main Results:
- No significant correlation was found between the length of the TAB specimen and a positive GCA diagnosis (P = 0.9).
- While the overall positive rate did not differ significantly between unilateral (16.8%) and bilateral (13.7%) biopsies, 2.7% of bilateral biopsies revealed discordant results (one side positive, the other negative).
Conclusions:
- TAB specimen length is not a significant factor in diagnosing GCA.
- Bilateral TABs, despite similar overall positive rates to unilateral biopsies, may offer a marginal increase in diagnostic yield due to the detection of discordant cases.
Background:
Giant cell arteritis (GCA) is the most common vasculitis in adults and is associated with significant morbidity and mortality. Temporal artery biopsy (TAB) remains the gold standard for diagnosis in the United States; however, practices vary in the length of artery obtained and whether bilateral simultaneous biopsies are obtained.
Methods:
Retrospective chart review of all TABs performed at the Johns Hopkins Wilmer Eye Institute between July 1, 2007, and September 30, 2017.
Results:
Five hundred eighty-six patients underwent TAB to evaluate for GCA. Of 404 unilateral biopsies, 68 (16.8%) were positive. Of 182 patients with bilateral biopsies, 25 (13.7%) had biopsies that were positive and 5 patients (2.7%) had biopsies that were discordant, meaning only 1 side was positive. There was no significant difference in the average postfixation length of positive and negative TAB specimens (positive mean length 1.38 ± 0.61 cm, negative mean length 1.39 ± 0.62 cm, P = 0.9).
Conclusions:
There is no significant association between greater length of biopsy and a positive TAB result in our data. Although the rate of positive results was not higher in the bilateral group compared with the unilateral group, 2.7% of bilateral biopsies were discordant, similar to previously published rates. Overall, this suggests that initial bilateral biopsy may increase diagnostic yield, albeit by a small amount.
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