Cristaudo Adam Thomas, Mizumoto Ryo, Hendahewa Rasika
Department of General Surgery, Caboolture Hospital, QLD, 4510, Australia; Westmead Research Centre for Evaluation of Surgical Outcomes, Department of Surgery, University of Sydney, Westmead Hospital, Westmead, NSW, 2145, Australia.
Department of General Surgery, Caboolture Hospital, QLD, 4510, Australia.
Ann Med Surg (Lond). 2016 Sep 20;11:47-51. doi: 10.1016/j.amsu.2016.09.004. eCollection 2016 Nov.
Giant cell arteritis (GCA) has the potential to cause irreversible blindness and stroke in affected patients [1-4]. Temporal artery biopsy (TAB) remains the gold standard test for GCA [6-8]. Recent literature suggests that TAB does not change management of patients with suspected GCA and that ultrasound scan (USS) may be sufficient enough alone to confirm the diagnosis [9-11,13]. The aim of this study is to therefore determine the impact of TAB on current surgical practice and emergency theatre services.
A retrospective clinical study was performed of patients who had undergone TAB at the Caboolture Hospital from January 2010 to September 2015. Demographic and clinical data was collected from patient's medical records in regards to GCA.
A total of 55 TAB were performed on 50 patients. Only two TAB were positive for GCA. Thirty-eight (76%) patients had a pre-TAB ACR criteria score of ≥3. Pre-operative corticosteroids were administered in forty-five (90%) patients, on average 4 ± 10 days pre-TAB. Mean time to TAB was 1.6 ± 1.6 days following their booking. Ninety-one percent of TAB were performed by surgical registrars. All TAB were performed using local anaesthesia alone.
TAB is an expensive procedure with a low positive yield. Recent evidence suggests promising results with USS in diagnosing GCA. With the exceedingly low positive TAB results found in this study, patients with suspected GCA should be investigated in accordance with the above algorithm. The routine use of USS will reduce the number of negative TAB performed.
巨细胞动脉炎（GCA）有可能导致受影响患者出现不可逆的失明和中风[1 - 4]。颞动脉活检（TAB）仍然是GCA的金标准检测方法[6 - 8]。最近的文献表明，TAB不会改变疑似GCA患者的治疗方案，并且超声扫描（USS）可能单独就足以确诊[9 - 11,13]。因此，本研究的目的是确定TAB对当前外科手术实践和急诊手术室服务的影响。
对2010年1月至2015年9月在卡布尔彻医院接受TAB的患者进行了一项回顾性临床研究。从患者的病历中收集有关GCA的人口统计学和临床数据。
共对50例患者进行了55次TAB。只有两次TAB的GCA检测呈阳性。38例（76%）患者TAB前的美国风湿病学会（ACR）标准评分≥3。45例（90%）患者在术前接受了皮质类固醇治疗，平均在TAB前4±10天给药。从预约到进行TAB的平均时间为1.6±1.6天。91%的TAB由外科住院医师进行。所有TAB均仅使用局部麻醉。
TAB是一种昂贵的检查方法，阳性率较低。最近的证据表明，USS在诊断GCA方面有良好的结果。鉴于本研究中发现的TAB阳性结果极低，疑似GCA的患者应按照上述算法进行检查。常规使用USS将减少阴性TAB的数量。
