Gajree S, Borooah S, Dhillon N, Goudie C, Smith C, Aspinall P, Dhillon B
S Gajree, 267 Crow Road, Glasgow G117BE UK. Email:
J R Coll Physicians Edinb. 2017 Jun;47(2):124-128. doi: 10.4997/JRCPE.2017.203.
Temporal artery biopsy is the gold standard investigation for the diagnosis of giant cell arteritis. The aim of this retrospective study was to investigate the use of temporal artery biopsy in diagnosing giant cell arteritis in south-east Scotland over a five-year period. We aimed to quantify success rates, and predictive factors for a positive biopsy, as well as compare the different specialities performing the biopsies. The data should enable the development of better criteria for referral for investigation of giant cell arteritis. Methods Patients were identified using a database of temporal artery biopsies generated by the pathology department in NHS Lothian (south east Scotland), for all biopsies examined between January 2010 and December 2015. An electronic patient record was used to retrospectively examine the records of patients in the database. Results A total of 715 biopsies were included in the study, of which 250 (35.0%) showed features of giant cell arteritis. The main predictors for a positive biopsy were age at biopsy, specialty performing biopsy, erythrocyte sedimentation rate, jaw claudication/pain, and ophthalmic symptoms. The most important predictor of a positive biopsy was erythrocyte sedimentation rate. The length of biopsy was not found to be a predictor of positive biopsy; however, diameter of biopsy was predictive. Conclusions We have shown that many temporal artery biopsies are negative, and finding ways to reduce the number of patients unnecessarily undergoing biopsy will be essential in reducing workload and streamlining services. This study demonstrates some key predictive factors for patients with positive biopsies. The study also shows that a large proportion of biopsies taking place do not result in the recommended length of specimen, but this does not necessarily reduce the likelihood of a positive biopsy.
颞动脉活检是诊断巨细胞动脉炎的金标准检查方法。这项回顾性研究的目的是调查在五年期间,苏格兰东南部使用颞动脉活检诊断巨细胞动脉炎的情况。我们旨在量化活检成功率、活检阳性的预测因素,并比较进行活检的不同专业。这些数据应有助于制定更好的巨细胞动脉炎转诊检查标准。方法利用NHS洛锡安(苏格兰东南部)病理科生成的颞动脉活检数据库,确定2010年1月至2015年12月期间所有接受检查的活检患者。使用电子病历对数据库中的患者记录进行回顾性检查。结果该研究共纳入715例活检,其中250例(35.0%)显示有巨细胞动脉炎特征。活检阳性的主要预测因素是活检时的年龄、进行活检的专业、红细胞沉降率、颌部跛行/疼痛和眼部症状。活检阳性的最重要预测因素是红细胞沉降率。未发现活检长度是活检阳性的预测因素;然而,活检直径具有预测性。结论我们已经表明,许多颞动脉活检结果为阴性,找到减少不必要接受活检患者数量的方法对于减轻工作量和优化服务至关重要。这项研究证明了活检阳性患者的一些关键预测因素。该研究还表明,进行的活检中有很大一部分未获得推荐的标本长度,但这不一定会降低活检阳性的可能性。