Temporal Artery Biopsy: A 10-Year Multi-centre Review of Current Practice

Background and objective Surgical teams are commonly requested to perform temporal artery biopsies (TAB) to assist in the diagnosis of giant cell arteritis (GCA). This study aimed to assess the clinical utility of TAB and its effect on the subsequent medical management of GCA. Methods We conducted a 10-year retrospective analysis of all patients who underwent TAB between 2011 and 2021 at three hospitals of a health network in Melbourne. Patient characteristics included accepted risk factors per the American College of Rheumatology (ACR), and whether treatment had been initiated before surgery. Surgical variables included biopsy specimen length, histopathology findings, and the mean time to theatre. Results Data were collected for 216 eligible patients, of whom 174 (80.6%) had commenced steroids before TAB. Forty patients (18.5%) had positive TAB results on histopathology. A significant proportion of patients (37.3%, n = 53) with negative TAB results completed their course of steroid therapy for GCA (p<0.05) despite negative histopathology. In addition, 32 patients (14.9% of total patients) underwent TAB despite pre-op documentation of the intention to continue steroid therapy regardless of biopsy results. There were no statistically significant factors identified between patient groups who continued or ceased steroid treatment post TAB, including TAB sample length. Colour Doppler ultrasound was only used in 6.98% of our study population.  Conclusions The utility of TAB in guiding medical management of GCA appears to be limited. A significant proportion of patients completed a full course of steroid therapy, irrespective of histopathology. Furthermore, 14.9% of patients underwent TAB despite pre-documented plans to continue steroid use regardless of the result. Further research is needed to update current clinical probability scores to include rigorous parameters to guide clinicians regarding the cessation of steroids.