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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.


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USS of a TAB specimen demonstrating classical hypoechoic 'halo sign’ of GCA (arrows). (Left) Cross sectional view. (Right) Longitudinal view.
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fig2: USS of a TAB specimen demonstrating classical hypoechoic 'halo sign’ of GCA (arrows). (Left) Cross sectional view. (Right) Longitudinal view.

Mentions: In mentioning the use of USS, recent evidence has surfaced in relation to its use in diagnosing GCA [9], [10], [11], [13]. The ‘halo sign’ characterised as a hypoechoic circumferential mural thickening localised around the lumen of an oedematous wall of a temporal artery seen on USS was first described by Schmidt et al. (Fig. 2) [18]. The presence of a ‘halo sign’ is highly specific for GCA (unilateral – 81%; bilateral – 100%) [19], [20]. The high value and validity of USS in the diagnosis has also been reported in three recently published meta-analyses and a comparative study is being performed of USS vs. TAB in the diagnosis of GCA [21], [22], [23], [24]. There is concern, however, of the potential for variations in user proficiency and limited ultrasonographer experience in regards to appropriately identifying the presence of this disease process successfully, especially in the regional hospital setting. Referral to a specialist tertiary centre where this imaging modality is more commonly used in diagnosis of GCA may aid in improving positive TAB results.


The impact of temporal artery biopsy on surgical practice
USS of a TAB specimen demonstrating classical hypoechoic 'halo sign’ of GCA (arrows). (Left) Cross sectional view. (Right) Longitudinal view.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

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

fig2: USS of a TAB specimen demonstrating classical hypoechoic 'halo sign’ of GCA (arrows). (Left) Cross sectional view. (Right) Longitudinal view.
Mentions: In mentioning the use of USS, recent evidence has surfaced in relation to its use in diagnosing GCA [9], [10], [11], [13]. The ‘halo sign’ characterised as a hypoechoic circumferential mural thickening localised around the lumen of an oedematous wall of a temporal artery seen on USS was first described by Schmidt et al. (Fig. 2) [18]. The presence of a ‘halo sign’ is highly specific for GCA (unilateral – 81%; bilateral – 100%) [19], [20]. The high value and validity of USS in the diagnosis has also been reported in three recently published meta-analyses and a comparative study is being performed of USS vs. TAB in the diagnosis of GCA [21], [22], [23], [24]. There is concern, however, of the potential for variations in user proficiency and limited ultrasonographer experience in regards to appropriately identifying the presence of this disease process successfully, especially in the regional hospital setting. Referral to a specialist tertiary centre where this imaging modality is more commonly used in diagnosis of GCA may aid in improving positive TAB results.

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.


Related in: MedlinePlus