title: Temporal artery biopsy is not required in all cases of suspected giant cell arteritis.
abstract: BACKGROUND
  Temporal artery biopsy (TAB) is performed during the diagnostic workup for giant cell arteritis (GCA), a vasculitis with the potential to cause irreversible blindness or stroke. However, treatment is often started on clinical grounds, and TAB result frequently does not influence patient management. The aim of this study was to assess the need for TAB in cases of suspected GCA.
  
  
  METHODS
  We performed a retrospective review of 185 TABs performed in our institution from 1990 to 2010. Patients were identified through the Hospital In-Patient Enquiry database and theater records. Clinical findings, erythrocyte sedimentation rate, steroid treatment preoperatively, American College of Rheumatology (ACR) criteria for GCA score, biopsy result, and follow-up were recorded.
  
  
  RESULTS
  Fifty-eight (31.4%) biopsies were positive for GCA. Presence of jaw claudication (P = 0.001), abnormal fundoscopy (P = 0.001), and raised erythrocyte sedimentation rate (P = 0.001) were significantly associated with GCA. The strongest association with positive biopsy was seen with the prebiopsy ACR score (P < 0.001). Twenty-four (13.7%) patients had undergone biopsy, despite no potential for meeting ACR criteria preoperatively. None of these were positive. Overall, 29 (16.4%) patients had management altered by TAB result.
  
  
  CONCLUSIONS
  Our results confirm that TAB does not affect management in the majority of patients with suspected GCA. We conclude that TAB has benefit only for patients who score 2 or 3 on the ACR criteria for GCA without biopsy.
authors.affiliation: Department of Academic Surgery, Cork University Hospital, Wilton, Cork, Ireland. edelquinn@rcsi.ie
authors.forename: Edel Marie
authors.initials: EM
authors.lastname: Quinn
authors.forename: David E
authors.initials: DE
authors.lastname: Kearney
authors.forename: Justin
authors.initials: J
authors.lastname: Kelly
authors.forename: Catherine
authors.initials: C
authors.lastname: Keohane
authors.forename: Henry Paul
authors.initials: HP
authors.lastname: Redmond
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001799:Blood Sedimentation; D016009:Chi-Square Distribution; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D013700:Giant Cell Arteritis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007494:Ireland; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019721:Ophthalmoscopes; D009887:Ophthalmoscopy; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013699:Temporal Arteries / Q000473:pathology*
chemical_list: D005938:Glucocorticoids