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Value of temporal artery biopsy length in diagnosing giant cell arteritis
Author(s) -
Oh Lawrence J.,
Wong Eugene,
Gill Anthony J.,
McCluskey Peter,
Smith James E. H.
Publication year - 2018
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.13822
Subject(s) - giant cell arteritis , medicine , biopsy , erythrocyte sedimentation rate , gold standard (test) , odds ratio , retrospective cohort study , arteritis , radiology , surgery , vasculitis , pathology , disease
Background Giant cell arteritis ( GCA ) is considered an ophthalmological emergency with severe sight and life‐threatening sequelae. Temporal artery biopsy ( TAB ) is the current gold standard for the diagnosis of GCA ; however, the required length of biopsy remains an issue of contention in the literature. Methods Retrospective case–control study of a consecutive cohort of 545 patients who had undergone TABs across five hospitals between 1 January 1992 and 1 January 2016. In patients with either positive or negative TABs , we collected age, sex, biopsy length and erythrocyte sedimentation rate ( ESR ). Results A total of 538 patients were included in the final analysis. Of these, 23.4% of TABs were positive, with the average length being 17.6 mm. There was a significant difference in means for positive (19.9 mm) and negative (16.8 mm) biopsies ( P = 0.0009). Each millimetre increase in TAB length increased the odds of a positive TAB by 3.4% ( P = 0.024). A cut‐off point of ≥15 mm increased the odds of a positive TAB by 2.25 compared with a TAB <15 mm ( P = 0.003). We also found that ESR ≥50 mm/h was a very strong predictor for a positive TAB result ( P < 0.0001). Conclusion Biopsy length and ESR were significant predictors of a pathological diagnosis of GCA . We also found that the optimal length threshold predictive for GCA was 15 mm in order to avoid a false‐negative GCA diagnosis. Although TAB remains the gold standard for diagnosis, clinicians should refer to both clinical and pathological data to guide their management.