title: Is colour duplex sonography-guided temporal artery biopsy useful in the diagnosis of giant cell arteritis? A randomized study.
abstract: OBJECTIVE
  The aim of this study was to assess the usefulness of colour duplex sonography (CDS)-guided temporal artery biopsy (TAB) for the diagnosis of GCA in patients with suspected GCA.
  
  
  METHODS
  From September 2009 through December 2012, 112 consecutive patients with suspected GCA were randomized to undergo CDS-guided TAB or standard TAB. All patients underwent temporal artery physical examination and temporal artery CDS prior to TAB. CDS of the temporal artery was performed by the same ultrasonographer, who was unaware of the patient's clinical data, and all TABs were evaluated by the same pathologist. Seven patients in whom biopsy failed to sample temporal artery tissue were excluded from the analysis.
  
  
  RESULTS
  Fifty patients were randomized to undergo CDS-guided TAB and 55 patients to standard TAB. Except for a younger age in patients who underwent standard TAB (P = 0.026), no significant differences were observed between the two groups. There were no significant differences in the frequencies of positive TAB for classic transmural inflammation (28% vs 18.2%) or for periadventitial small vessel vasculitis and/or vasa vasorum vasculitis (6% vs 14.5%) between the two groups. No significant differences in the frequency of positive TAB in the two groups were observed when we excluded the patients treated with glucocorticoids and when we stratified the patients of the two groups for the presence or absence of the halo sign.
  
  
  CONCLUSIONS
  Our study showed that CDS-guided TAB did not improve the sensitivity of TAB for diagnosing GCA.
authors.affiliation: Rheumatology Unit, Department of Internal Medicine, Ophthalmology Unit, Department of Surgery, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Department of Internal Medicine, University of Messina, Messina and Pathology Unit, Department of Oncology, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Germanò
authors.affiliation: Rheumatology Unit, Department of Internal Medicine, Ophthalmology Unit, Department of Surgery, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Department of Internal Medicine, University of Messina, Messina and Pathology Unit, Department of Oncology, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Muratore
authors.affiliation: Rheumatology Unit, Department of Internal Medicine, Ophthalmology Unit, Department of Surgery, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Department of Internal Medicine, University of Messina, Messina and Pathology Unit, Department of Oncology, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Cimino
authors.affiliation: Rheumatology Unit, Department of Internal Medicine, Ophthalmology Unit, Department of Surgery, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Department of Internal Medicine, University of Messina, Messina and Pathology Unit, Department of Oncology, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Lo Gullo
authors.affiliation: Rheumatology Unit, Department of Internal Medicine, Ophthalmology Unit, Department of Surgery, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Department of Internal Medicine, University of Messina, Messina and Pathology Unit, Department of Oncology, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy.
authors.forename: Niccolò
authors.initials: N
authors.lastname: Possemato
authors.affiliation: Rheumatology Unit, Department of Internal Medicine, Ophthalmology Unit, Department of Surgery, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Department of Internal Medicine, University of Messina, Messina and Pathology Unit, Department of Oncology, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Macchioni
authors.affiliation: Rheumatology Unit, Department of Internal Medicine, Ophthalmology Unit, Department of Surgery, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Department of Internal Medicine, University of Messina, Messina and Pathology Unit, Department of Oncology, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cavazza
authors.affiliation: Rheumatology Unit, Department of Internal Medicine, Ophthalmology Unit, Department of Surgery, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Department of Internal Medicine, University of Messina, Messina and Pathology Unit, Department of Oncology, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy.
authors.forename: Nicolò
authors.initials: N
authors.lastname: Pipitone
authors.affiliation: Rheumatology Unit, Department of Internal Medicine, Ophthalmology Unit, Department of Surgery, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Department of Internal Medicine, University of Messina, Messina and Pathology Unit, Department of Oncology, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Boiardi
authors.affiliation: Rheumatology Unit, Department of Internal Medicine, Ophthalmology Unit, Department of Surgery, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Department of Internal Medicine, University of Messina, Messina and Pathology Unit, Department of Oncology, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy. salvarani.carlo@asmn.re.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Salvarani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D005260:Female; D013700:Giant Cell Arteritis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013699:Temporal Arteries / Q000000981:diagnostic imaging* / Q000473:pathology*; D018615:Ultrasonography, Doppler, Color / Q000379:methods*
chemical_list: D005938:Glucocorticoids
keywords: colour duplex sonography; giant cell arteritis; glucocorticoid therapy; guided temporal artery biopsy; halo sign; periadventitial small vessel vasculitis; randomization; temporal artery physical examination; transmural vasculitis; vasa vasorum vasculitis