title: Temporal artery biopsy as a means of diagnosing giant cell arteritis: is there over-utilization?
abstract: Temporal artery biopsy (TAB) is often recommended for patients suspected of having temporal arteritis. The sensitivity of TAB varies widely and is dependent upon a number of factors (e.g., number of biopsy specimens, corticosteroid pretreatment, specimen length). The purpose  of this study was to determine the clinical utility of TAB in patients who are suspected of having giant cell arteritis (GCA). A retrospective review of patients who underwent TAB at Spectrum Health from January 1, 1998 to December 31, 2007 was performed. Forty-seven patients, ranging in age  from 25 to 87 years (mean: 70.7 years), underwent 53 TABs. Females accounted for 72.3 per cent of the subjects. Positive biopsy results showing signs of GCA were obtained in 38.3 per cent of patients. Of patients who underwent biopsy, 78 per cent could have been excluded from the procedure  based upon individual diagnostic criteria. Positive and negative biopsies had average lengths of 1.84 cm and 1.29 cm, respectively (P < 0.05). In the community hospital setting, patients suspected of having GCA are frequently recommended to undergo unnecessary TAB. We advocate for  more careful selection of patients to undergo this diagnostic surgical procedure. In cases where TAB is needed, we recommend a biopsy length of > 2 cm to increase the accuracy of diagnosis.
authors.affiliation: Michigan State University, General Surgery Residency, Grand Rapids, Michigan, USA. goslinbr@msu.edu
authors.forename: Brent J
authors.initials: BJ
authors.lastname: Goslin
authors.forename: Mathew H
authors.initials: MH
authors.lastname: Chung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000706:statistics & numerical data*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D013700:Giant Cell Arteritis / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013699:Temporal Arteries / Q000473:pathology*