Incidence of discordant temporal artery biopsy in the diagnosis of giant cell arteritis.
OBJECTIVE
We investigated the rate of discordant biopsy results (i.e., 1 side negative, 1 side positive) in patients who underwent initial bilateral temporal artery biopsies for suspected giant cell arteritis (GCA).


METHODS
A cohort study.


METHODS
Consecutive patients undergoing temporal artery biopsy were enrolled. Of the 259 patients enrolled, 250 underwent initial bilateral temporal artery biopsies.


METHODS
Positive biopsies were defined based on accepted histologic definitions. Healed arteritis was considered a positive result. Clinical information was collected for all patients using a questionnaire administered by an ophthalmologist. Pathology results, including biopsy length (as measured by the pathologist), and laboratory information (i.e., serum erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP] levels) were collected from digital patient records for statistical analysis. The main outcome was the rate of discordant biopsy in consecutive patients who underwent initial bilateral temporal artery biopsy.


RESULTS
Giant cell arteritis was confirmed in 62 (24.2%) of the 250 patients, including 3 patients with biopsies recorded as healed arteritis. The rate of discordant biopsy was 4.4% with 11 unilaterally positive biopsies. There was no statistical difference between the length of the left- and right-sided biopsies in either the unilaterally or bilaterally positive groups (p = 0.13 and p = 0.79, respectively). The average maximum ESR value for the bilateral group (58.7 mm/h) was significantly higher than the average maximum ESR value for the unilateral group (30.7 mm/h, p = 0.03). The average maximum CRP value for the bilateral group was 59.2 mg/L and 28.6 mg/L for the unilateral group (p = 0.30). Discordance between the localization of symptoms and the side of positive biopsy occurred in 3 patients (i.e., 3 patients had left-sided symptoms only, yet a right-sided positive biopsy).


CONCLUSIONS
The rate of discordant biopsies in patients who underwent initial bilateral temporal artery biopsies was considerable in our patient cohort. Given this reasonably high rate of discordance between sides, as well as the lack of correlation between side of positivity and laterality of presenting symptoms, we recommend initial bilateral temporal artery biopsies to enhance the diagnostic certainty of the disease.
Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, N.S.
Bethany
B
Durling
Department of Ophthalmology, Hôpital du Saint Sacrement, Université Laval, Québec, Qué.
Andrew
A
Toren
Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Md.
Vivek
V
Patel
Department of Ophthalmology, University of Ottawa Eye Institute, Ottawa, Ont.
Steven
S
Gilberg
Department of Ophthalmology, University of Alberta, Edmonton, Alta.
Ezekiel
E
Weis
Department of Ophthalmology, University of Ottawa Eye Institute, Ottawa, Ont.. Electronic address: jordan1897@rogers.com.
David
D
Jordan
D000368:Aged; D001706:Biopsy; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D015331:Cohort Studies; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D013700:Giant Cell Arteritis / Q000175:diagnosis*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008297:Male; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D013699:Temporal Arteries / Q000473:pathology*
D005938:Glucocorticoids; D002097:C-Reactive Protein