The Utility of the Bilateral Temporal Artery Biopsy for Diagnosis of Giant Cell Arteritis

• Published in: Journal of vascular surgery 2022-12, Vol.76 (6), p.1704-1709
• Main Authors: Mehta, Kunal, Eid, Mark, Gangadharan, Arati, Pritchard, Abiah, Lin, Chun-Chieh, Goodney, Phillip, Stableford, Jennifer
• Format: Article
• Language: English
• Subjects: Aged; Biopsy - methods; Female; Giant cell arteritis; Giant Cell Arteritis - diagnosis; Giant Cell Arteritis - pathology; Humans; Neoadjuvant Therapy; NESVS 2021 Annual Meeting; Retrospective Studies; Temporal Arteries - diagnostic imaging; Temporal Arteries - pathology; Temporal Arteries - surgery; temporal artery biopsy; temporal artery duplex
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2022.04.043

A surgical temporal artery biopsy (TAB) is the gold standard for diagnosis of giant cell arteritis (GCA). The necessity of performing a bilateral biopsy remains under debate. The primary objective of this study was to assess the rate of discordance between pathology results in patients who underwent bilateral temporal artery biopsy for suspected GCA. We performed a retrospective review of patients who underwent bilateral temporal artery biopsy for diagnosis of GCA between 2011 and 2020. The primary endpoint was the rate of discordance between specimens for patients with pathology positive GCA. Secondary endpoints included assessments of the sensitivity of pre-operative temporal artery duplex and the effects of specimen length and specialty of referring provider on the diagnostic yield of the biopsy. During the study period, 310 patients underwent bilateral temporal artery biopsy for diagnosis of giant cell arteritis. These patients were primarily female (73.9%), elderly (mean age 70.8 years), and Caucasian (95.8%). Pre-operative symptoms for patients were typically bilateral (59%) and included headache (81%), vision changes (45.2%), and temporal tenderness (32.6%). Most patients (85.2%) were on pre-operative steroid therapy at the time of surgical biopsy with a mean pre-operative duration of steroid therapy of 15.1 days. Overall, 91 patients (29.4%) had a positive pathologic diagnosis after bilateral temporal artery biopsy. Of these patients, 11 had a positive pathology result in only a single specimen, resulting in a discordance rate of 12.1%. Pre-operative temporal artery duplex demonstrated low sensitivity (27.3%) for identifying patients with pathologic positive disease. There were no significant differences between the pathology positive and negative patients in terms of mean surgical specimen length (1.67 vs 1.64 cm; p = 0.67) or specialty of referring provider (p = 0.73). At our institution, we observed a 12.1% discordance rate between pathology results in patients who underwent bilateral temporal artery biopsy for diagnosis of GCA. A pre-operative temporal artery duplex provided little value in identifying patients with biopsy-proven GCA.