Temporal artery biopsy...who needs one?
OBJECTIVE
To review a 10 year period of temporal artery biopsies, using the American College of Rheumatology (ACR) 1990 criteria: a five point scoring system for the diagnosis of giant cell arteritis (GCA).


METHODS
Population based, retrospective cohort analysis.


METHODS
One district general hospital in the United Kingdom, over one decade.


METHODS
All patients who underwent temporal artery biopsy from July 1994 to June 2004.


METHODS
ACR score and temporal artery biopsy result.


RESULTS
During the 10 year period 111 patients were identified. The median (range) age at presentation was 71 (29-85) years. Seventy five patients had an initial ACR score of three or four at presentation. There were 20 positive biopsy specimens. In 19 of these cases at least three of the other criteria were positive so there was already sufficient clinical information for a confident diagnosis. In only one case did the positive result influence the diagnosis by changing the ACR score from two to three. In our series, corticosteroid treatment before biopsy did not significantly reduce the yield of the biopsy.


CONCLUSIONS
The ACR score of three or more has a sensitivity of 93.5% and specificity of 91.2% for the diagnosis of GCA. Using these criteria, 68% of patients had sufficient clinical features when referred to make a confident diagnosis of GCA. Temporal artery biopsy was therefore unnecessary in this group. In the remaining group (ACR score < or =2) there was one positive biopsy. The biopsy only changed the diagnosis in this one case-less than 3% of the uncertain cases and less than 1% of the total cases. Using the ACR criteria and restricting biopsy to those cases in which it might change the diagnosis will reduce the number of biopsies by two thirds without jeopardising diagnostic accuracy.
Davies
C
C
Department of Vascular Surgery, Royal Gwent Hospital, Newport, UK.
Frost
B
B
Eshan
O
O
McLain
A D
AD
Shandall
A
A
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D013700:Giant Cell Arteritis / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D012189:Retrospective Studies; D013699:Temporal Arteries / Q000473:pathology*
D000305:Adrenal Cortex Hormones