C. Deyholos1, M. Systek1, S. Smith1, J. Cardella1, K. C. Orion1 1Yale University School Of Medicine,Section Of Vascular Surgery, Department Of Surgery,New Haven, CT, USA
Introduction: Temporal arteritis (TA) or giant cell arteritis (GCA) is a systemic inflammatory vasculitis of unclear etiology that affects medium sized vessels. The gold standard for diagnosis has traditionally been histological by TA biopsy. Due to the risk of permanent vision loss if the disease is left untreated, standard of care is to begin steroid therapy prior to confirming the diagnosis. In up to one third of GCA patients, the temporal arteries are not involved and there has been reported facial nerve injury during TA biopsy. Improved imaging modalities such as color duplex, PET CT or MRI have been increasingly used to aid diagnosis and are recommended in the newest 2018 European (EULAR) Guidelines. We hypothesize that a negative TA biopsy result does not change management in patients for whom temporal arteritis is strongly suspected and that duplex ultrasound can be successfully used as a screening tool.
Methods: A retrospective review of patients undergoing TA biopsy between May 1, 2012 and December 31, 2015. We reviewed patient's age, gender, co-morbidities, symptoms, histology, and whether patients were prescribed steroids prior to or following biopsy. We also began small prospective series of 3 patients where ultrasound of the bilateral temporal arteries was performed prior to biopsy, using a high frequency linear transducer to evaluate for wall thickening. Radiology report and pathology report were then reviewed.
Results: Within period of study, 171 temporal artery biopsies were performed. 7.6% positive (n=13) 92.4% negative (n=158) for acute GCA. Patients with positive biopsy result had mean age 80± 6 (Range 69-88). Patients with negative biopsy had mean age of 72± 11 (Range 17-95). We also performed subgroup analysis on patients with negative biopsies (n=158). Cases in which there was no documentation of steroids prior to or after biopsy were excluded (n=15). 20% of patients who had negative biopsies were not on steroids prior to the procedure (n=28). 31% of patients with negative biopsies continued on steroids despite the negative result (n=45). In series of 3 ultrasounds, all 3 correlated with subsequent biopsy histology. 1 was positive, and 2 were negative.
Conclusion: Our results suggest that the yield of temporal artery biopsy is low, and a negative biopsy alone often does not lead to termination of steroid therapy. Ultrasound may present a viable diagnostic tool to reduce number of unnecessary temporal artery biopsies performed.
