Basic and patient-oriented research
Evaluation for Clinical Predictors of Positive Temporal Artery Biopsy in Giant Cell Arteritis

https://doi.org/10.1016/j.joms.2010.02.027Get rights and content

Purpose

To examine the clinical predictors of a positive temporal artery biopsy (TAB) among patients suspected of having giant cell arteritis.

Patients and Methods

We conducted a retrospective study of all consecutive patients who underwent TAB by a single surgeon (K.L.R.) at the Department of Oral Maxillofacial Surgery from April 30, 2002, to June 29, 2006. The medical records were reviewed for the clinical symptoms, laboratory findings, biopsy results, and final diagnosis. The variables of interest as predictors of positive biopsy findings were analyzed using logistic regression analysis.

Results

During the study period, 82 patients underwent TAB. Histologic evidence of arteritis was present in 22 patients (26.8%). Two (2.4%) were diagnosed with giant cell arteritis clinically but had negative TAB findings. The patients presenting with weight loss or jaw claudication were more likely to have a positive TAB finding (odds ratio 4.50, 95% confidence interval 1.45 to 13.93; and odds ratio 3.71, 95% confidence interval 1.28 to 10.76, respectively). No laboratory findings were predictive of a positive TAB finding. Prednisone use before TAB also was not associated with a decreased likelihood of a positive finding.

Conclusions

Patients suspected of having giant cell arteritis were more likely to have a positive TAB finding if they presented with weight loss or jaw claudication. In the present series, corticosteroid therapy before biopsy did not affect the rate of positive TAB findings.

Section snippets

Study Design

The present study was a retrospective case series of all consecutive patients who had undergone TAB by 1 OMFS surgeon (K.L.R.) at the Mayo Clinic from April 20, 2002, to June 29, 2006. The Mayo Clinic institutional review board approved the study (institutional review board study 06-005021).

Case Retrieval

The surgical indexing records were used to identify consecutive patients who had undergone TAB by 1 surgeon (K.L.R.) during the study period. All medical records were reviewed.

Case Definitions

GCA was diagnosed by positive

Results

During the study period, 82 patients (54 women and 28 men) underwent TAB by a single provider in OMFS. The median age at biopsy was 72 years (range, 41 to 91). The presenting symptoms of the patients referred for TAB are summarized in Table 1. Headache was the most common symptom (61.0% of patients). Jaw claudication was present in 25.6% of patients. Eight patients had concurrent PMR. The median ESR at presentation was 41 mm/hour (range, 2 to 142). The median CRP at biopsy was 2.5 mg/dL (range,

Discussion

According to previous studies, up to two thirds of all TAB findings obtained could be negative.6, 7, 8 Therefore, although TAB remains the reference standard for diagnosis in patients suspected of having GCA, it can be challenging to determine the subset of patients most likely to have this disease. Identifying the clinical determinants of positive TAB findings might help physicians recognize those at high risk and therefore initiate prompt therapy. In the present study, we found that patients

References (14)

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Cited by (16)

  • Jaw claudication is the only clinical predictor of giant-cell arteritis

    2017, Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology
    Citation Excerpt :

    Although several imaging techniques as alternative diagnostic strategies have recently become available to investigate patients with suspected GCA [16–21], reduced sensitivity and specificity may hamper their effectiveness. Laboratory markers (e.g. CRP levels, ESR) and clinical features (e.g. abrupt-onset headache, temporal cutaneous hyperalgesia, jaw claudication, diplopia) are also useful as clinical predictors for the implementation of TAB [1–13]. Among these clinical predictors, jaw claudication is especially important as it can be discovered by a dentist [22].

  • The effect of temporal artery biopsy on the treatment of temporal arteritis

    2015, American Journal of Surgery
    Citation Excerpt :

    Up to two thirds of biopsies are negative, suggesting that it can be difficult for clinicians to determine, which patients have GCA. Because GCA can exhibit “skip lesions” on microscopy, the accuracy of pathologic diagnosis depends on several patient and surgeon factors: pretreatment with corticosteroids, length of biopsy, and unilateral versus bilateral biopsies.3,9–15 Some studies have examined the ACR criteria individually with the aim of reducing the number of negative biopsies and have shown that the presence of certain individual criteria including jaw claudication and double vision have a stronger positive predictive value of GCA than other criteria.16

  • Demographic and laboratory data may predict positive temporal artery biopsy

    2011, Journal of Surgical Research
    Citation Excerpt :

    Therefore, it would be beneficial to identify demographic and laboratory data that would increase the likelihood of a positive temporal artery biopsy. There have been several previous studies attempted to determine whether clinical criteria can be used for early identification of GCA [9, 10]. However, the criteria identified in these studies were considered to be insufficient for establishing a diagnosis, and TAB is still the gold standard for a definitive diagnosis.

  • The Impact of Temporal Artery Biopsy at a UK Tertiary Plastic Surgery Unit

    2019, Plastic and Reconstructive Surgery - Global Open
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