Advertisement

Intraoperative findings during temporal artery biopsy: keys to optimise the diagnosis of giant cell arteritis

Published:November 26, 2021DOI:https://doi.org/10.1016/j.bjoms.2021.11.015

      Abstract

      The objective of this study was to describe the perioperative findings during temporal artery biopsy (TAB) and the characteristics associated with a diagnosis of giant cell arteritis (GCA). Perioperative findings were prospectively described by a single operator blinded to the clinical and laboratory characteristics of the patients on 40 consecutive TABs, of which 21 were positive (53%) for GCA. Patients with a TAB positive for GCA (TAB+) more frequently had abnormalities on palpation of the temporal artery than negative TAB (TAB-) patients (mainly pulse abolition (p=0.007), indurated artery (p=0.002), and painful artery (p=0.021)). The appearance of a big artery (p<0.001), a thickened artery (p<0.001), and an indurated artery at incision (p<0.001) was significantly associated with a positive TAB. A multivariate model identified a big artery, no local bleeding, and pain during artery traction as being associated with TAB positivity (sensitivity 71.4% and specificity 89.5%). The appearance of the temporal artery during TAB is important in predicting the positivity of the biopsy. Whether this should influence the optimal length of the TAB warrants a prospective study.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to British Journal of Oral and Maxillofacial Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Weyand C.M.
        • Goronzy J.J.
        Giant-cell arteritis and polymyalgia rheumatica.
        N Engl J Med. 2014; 371: 1653
        • Rubenstein E.
        • Maldini C.
        • Gonzalez-Chiappe S.
        • et al.
        Sensitivity of temporal artery biopsy in the diagnosis of giant cell arteritis: a systematic literature review and meta-analysis.
        Rheumatology (Oxford). 2020; 59: 1011-1020
        • Niederkohr R.D.
        • Levin L.A.
        A Bayesian analysis of the true sensitivity of a temporal artery biopsy.
        Invest Ophthalmol Vis Sci. 2007; 48: 675-680
        • Muratore F.
        • Boiardi L.
        • Cavazza A.
        • et al.
        Association between specimen length and number of sections and diagnostic yield of temporal artery biopsy for giant cell arteritis.
        Arthritis Care Res (Hoboken). 2021; 73: 402-408
        • Yoon M.K.
        • Horton J.C.
        • McCulley T.J.
        Facial nerve injury: a complication of superficial temporal artery biopsy.
        Am J Ophthalmol. 2011; 152: 251.e1
        • Hunder G.G.
        • Bloch D.A.
        • Michel B.A.
        • et al.
        The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis.
        Arthritis Rheum. 1990; 33: 1122-1128
        • de Boysson H.
        • Dumont A.
        • Liozon E.
        • et al.
        Giant-cell arteritis: concordance study between aortic CT angiography and FDG-PET/CT in detection of large-vessel involvement.
        Eur J Nucl Med Mol Imaging. 2017; 44: 2274-2279
        • Chan F.L.
        • Lester S.
        • Whittle S.L.
        • et al.
        The utility of ESR, CRP and platelets in the diagnosis of GCA.
        BMC Rheumatol. 2019; 3: 14
        • Nakache J.P.
        • Confais J.
        Statistique explicative appliquée.
        Technip. 2003; : 58-60
        • Cetinkaya A.
        • Kersten R.C.
        • Brannan P.A.
        • et al.
        Intraoperative predictability of temporal artery biopsy results.
        Ophthalmic Plast Reconstr Surg. 2008; 24: 372-377
        • Karahaliou M.
        • Vaiopoulos G.
        • Papaspyrou S.
        • et al.
        Colour duplex sonography of temporal arteries before decision for biopsy: a prospective study in 55 patients with suspected giant cell arteritis.
        Arthritis Res Ther. 2006; 8: R116
        • Marano S.R.
        • Fischer D.W.
        • Gaines C.
        • et al.
        Anatomical study of the superficial temporal artery.
        Neurosurgery. 1985; 16: 786-790
        • Tomsak R.L.
        Superficial temporal artery biopsy. A simplified technique.
        J Clin Neuroophthalmol. 1991; 11: 202-204
        • Markose G.
        • Graham R.M.
        Gillies temporal incision: an alternate approach to superficial temporal artery biopsy.
        Br J Oral Maxillofac Surg. 2017; 55: 719-721