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The impact of temporal artery biopsy on surgical practice

View Article: PubMed Central - PubMed

ABSTRACT

Background: Giant cell arteritis (GCA) has the potential to cause irreversible blindness and stroke in affected patients [1–4]. Temporal artery biopsy (TAB) remains the gold standard test for GCA [6–8]. Recent literature suggests that TAB does not change management of patients with suspected GCA and that ultrasound scan (USS) may be sufficient enough alone to confirm the diagnosis [9–11,13]. The aim of this study is to therefore determine the impact of TAB on current surgical practice and emergency theatre services.

Materials and methods: A retrospective clinical study was performed of patients who had undergone TAB at the Caboolture Hospital from January 2010 to September 2015. Demographic and clinical data was collected from patient's medical records in regards to GCA.

Results: A total of 55 TAB were performed on 50 patients. Only two TAB were positive for GCA. Thirty-eight (76%) patients had a pre-TAB ACR criteria score of ≥3. Pre-operative corticosteroids were administered in forty-five (90%) patients, on average 4 ± 10 days pre-TAB. Mean time to TAB was 1.6 ± 1.6 days following their booking. Ninety-one percent of TAB were performed by surgical registrars. All TAB were performed using local anaesthesia alone.

Conclusions: TAB is an expensive procedure with a low positive yield. Recent evidence suggests promising results with USS in diagnosing GCA. With the exceedingly low positive TAB results found in this study, patients with suspected GCA should be investigated in accordance with the above algorithm. The routine use of USS will reduce the number of negative TAB performed.

No MeSH data available.


High-power view of a positive TAB specimen shows disruption of the intima with a collection of multinucleated giant cells.
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fig1: High-power view of a positive TAB specimen shows disruption of the intima with a collection of multinucleated giant cells.

Mentions: Of the 55 TAB performed, only 2 (3.6%) specimens were reported as positive for GCA (both were female) (Fig. 1). Four (7.2%) specimens were reported as insufficient sample size (i.e. specimens <10 mm; three of these being from same patient), one (1.8%) specimen yielded a vein and one (1.8%) specimen yielded a peripheral nerve. The remaining 47 (86%) specimens reported as negative for GCA; four (7.2%) of which showed age-related changes, one (1.8%) showing degenerative changes.


The impact of temporal artery biopsy on surgical practice
High-power view of a positive TAB specimen shows disruption of the intima with a collection of multinucleated giant cells.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037119&req=5

fig1: High-power view of a positive TAB specimen shows disruption of the intima with a collection of multinucleated giant cells.
Mentions: Of the 55 TAB performed, only 2 (3.6%) specimens were reported as positive for GCA (both were female) (Fig. 1). Four (7.2%) specimens were reported as insufficient sample size (i.e. specimens <10 mm; three of these being from same patient), one (1.8%) specimen yielded a vein and one (1.8%) specimen yielded a peripheral nerve. The remaining 47 (86%) specimens reported as negative for GCA; four (7.2%) of which showed age-related changes, one (1.8%) showing degenerative changes.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Giant cell arteritis (GCA) has the potential to cause irreversible blindness and stroke in affected patients [1&ndash;4]. Temporal artery biopsy (TAB) remains the gold standard test for GCA [6&ndash;8]. Recent literature suggests that TAB does not change management of patients with suspected GCA and that ultrasound scan (USS) may be sufficient enough alone to confirm the diagnosis [9&ndash;11,13]. The aim of this study is to therefore determine the impact of TAB on current surgical practice and emergency theatre services.

Materials and methods: A retrospective clinical study was performed of patients who had undergone TAB at the Caboolture Hospital from January 2010 to September 2015. Demographic and clinical data was collected from patient's medical records in regards to GCA.

Results: A total of 55 TAB were performed on 50 patients. Only two TAB were positive for GCA. Thirty-eight (76%) patients had a pre-TAB ACR criteria score of &ge;3. Pre-operative corticosteroids were administered in forty-five (90%) patients, on average 4&nbsp;&plusmn;&nbsp;10 days pre-TAB. Mean time to TAB was 1.6&nbsp;&plusmn;&nbsp;1.6 days following their booking. Ninety-one percent of TAB were performed by surgical registrars. All TAB were performed using local anaesthesia alone.

Conclusions: TAB is an expensive procedure with a low positive yield. Recent evidence suggests promising results with USS in diagnosing GCA. With the exceedingly low positive TAB results found in this study, patients with suspected GCA should be investigated in accordance with the above algorithm. The routine use of USS will reduce the number of negative TAB performed.

No MeSH data available.