title: The effect of temporal artery biopsy on the treatment of temporal arteritis.
abstract: BACKGROUND
  Temporal artery biopsy (TAB) is frequently used to guide treatment for suspected temporal arteritis. Our purpose was to determine the influence on subsequent temporal arteritis treatment, particularly the initiation, termination, or continuation of corticosteroids after a histologically negative TAB.
  
  
  METHODS
  This is a retrospective analysis from a single regional referral center on all patients undergoing TAB March 2003 through November 2010. Demographic, clinical, and surgical informations were recorded including changes in treatment based on biopsy results.
  
  
  RESULTS
  In all, 237 patients had complete documentation for review; the average age was 71 years (range 34 to 94) and 56% were women. Thirty-six patients had 42 positive biopsies; 26 biopsies were bilateral. Positive biopsy results were defined as having marked intimal thickening, transmural inflammation, and "giant cells." Neither length of biopsy specimen nor preoperative steroid use affected pathologic diagnosis (2.41 vs 2.38 cm, P = .46, and 52% vs 50%, P = .8, respectively). Symptoms included new-onset headache (75%), preauricular tenderness and jaw claudication (32%), erythrocyte sedimentation rate greater than 50 mm/h (60%), and a score of 3 or more using the American College of Rheumatology criteria (56%). Among the 56% of patients who met the criteria for the clinical diagnosis of temporal arteritis, 22% demonstrated a positive biopsy. Biopsy results had no significant impact on subsequent treatment in 69% of patients who met clinical diagnostic criteria (P = .7); in the remaining 31%, biopsy results altered subsequent treatment with either corticosteroid initiation or discontinuation.
  
  
  CONCLUSIONS
  The pathologic results of the TAB did not significantly affect treatment in most patients.
authors.affiliation: South East Area Health Education Center, Department of Surgery, New Hanover Regional Medical Center, Wilmington, NC, 28401, USA.
authors.forename: Khoi
authors.initials: K
authors.lastname: Le
authors.affiliation: South East Area Health Education Center, Department of Surgery, New Hanover Regional Medical Center, Wilmington, NC, 28401, USA.
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Bools
authors.affiliation: South East Area Health Education Center, Department of Surgery, New Hanover Regional Medical Center, Wilmington, NC, 28401, USA.
authors.forename: Allison B
authors.initials: AB
authors.lastname: Lynn
authors.affiliation: South East Area Health Education Center, Department of Surgery, New Hanover Regional Medical Center, Wilmington, NC, 28401, USA.
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Clancy
authors.affiliation: South East Area Health Education Center, Department of Surgery, New Hanover Regional Medical Center, Wilmington, NC, 28401, USA.
authors.forename: W Borden
authors.initials: WB
authors.lastname: Hooks
authors.affiliation: South East Area Health Education Center, Department of Surgery, New Hanover Regional Medical Center, Wilmington, NC, 28401, USA. Electronic address: william.hope@seahec.net.
authors.forename: William W
authors.initials: WW
authors.lastname: Hope
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D005260:Female; D013700:Giant Cell Arteritis / Q000188:drug therapy / Q000473:pathology*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013699:Temporal Arteries / Q000473:pathology*
chemical_list: D005938:Glucocorticoids
keywords: Biopsy; Corticosteroids; Giant cell arteritis; Temporal arteritis