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Temporal Artery Biopsy for Giant Cell Arteritis
REGINA TAYLOR-GJEVRE, MINH VO, DINO SHUKLA, and LOTHAR RESCH ABSTRACT. Objective. To evaluate the influence of temporal artery biopsy (TAB) techniques on establishing a diagnosis of giant cell arteritis (GCA). Methods. A retrospective review of 141 TAB pathology records from 1996 to 2002 was conducted. Histopathology slides on 136 TAB were reviewed by a single, independent, blinded pathologist. Results. The population included 101 (71.6%) women, mean age 75.8 years (range 45–92), and 40 men, mean age 73.9 years (range 47–90). The mean length of a TAB sample after formalin fixation was 1.76 cm (range 0.1–5.3). Surgeons performing the TAB represented 6 disciplines. Ophthalmologists had the largest volume, at 78 biopsies (55.3%), and the longest segments of artery, with a mean length of 2.37 cm (range 0.4–5.3) (p < 0.001). Comparison of biopsy interpretation provided a kappa coefficient of 0.8 (95% CI 0.69, 0.91). The 38 (27%) positive biopsies had a mean length of 2.07 cm (SD 1.1), and the 98 negative biopsies a mean length of 1.69 cm (SD 1.04) (p = 0.058). Biopsies < 1.0 cm length (n = 35, 25.7%) were less likely to be positive than those ≥ 1.0 cm (p = 0.037). No significant differences in surgical discipline, hospital site, number of slides, or cross-sections/cm artery were found between the positive and negative biopsies. Conclusion. Biopsy specimens reported positive for GCA tended to be longer than those reported as negative. A "threshold" size of 1.0 cm is associated with increased diagnostic yield. Lack of standardization of biopsy harvesting and processing techniques may contribute to variable sensitivity of TAB. (J Rheumatol 2005;32:1279-82) Key Indexing Terms:
TEMPORAL ARTERITIS From the Division of Rheumatology, Department of Medicine, and the Department of Internal Medicine, University of Saskatchewan, Saskatoon, Saskatchewan; and the Department of Pathology, University of Alberta, Edmonton, Alberta, Canada. R.M. Taylor-Gjevre, MD, FRCPC, Division of Rheumatology; M. Vo, MD; D. Shukla, MD, Department of Internal Medicine, University of Saskatchewan; L. Resch, MD, FRCPC, Department of Pathology, University of Alberta. Address reprint requests to Dr. R.M. Taylor-Gjevre, Division of Rheumatology, Department of Medicine, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada. Accepted for publication February 21, 2005. |