Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich, UK.
Norwich Medical School, University of East Anglia, Norwich, UK.
Clin Rheumatol. 2020 Apr;39(4):1325-1329. doi: 10.1007/s10067-019-04772-2. Epub 2019 Oct 1.
Currently, there is no mechanism for service validation of diagnostic ultrasonography (US) for giant cell arteritis (GCA). Temporal artery biopsy (TAB) and classification criteria are poor benchmarks. We validated our service against physician-verified diagnosis at 100 weeks (100wD). Twenty-five patients underwent US within 7 days, and TAB within 28 days, of commencing prednisolone. US, TAB and baseline diagnosis (bD) were all compared with 100wD using Cohen's kappa. Fourteen US and 8 TABs were positive. Twenty at baseline and 14 at 100 weeks had diagnosis of GCA. The kappa (95% CI) were 0.4 (0.1, 0.7) for US vs. TAB; 0.5 (0.2, 0.8) for US vs. bD and 0.2 (0.0, 0.4) for TAB vs. bD. Versus 100wD, the kappa (95% CI) were 0.8 (0.6, 1.0) for US; 0.4 (0.1, 0.7) for TAB and 0.6 (0.3, 0.9) for bD. Seven cases were US+/TAB-. Four had alternate confirmation: 18FDG-PET (n = 1), CT Aorta (n = 1) and US at relapse (n = 2). At 100 weeks, 4 cases (all US-/TAB-) with bD of GCA had alternative diagnoses including cancer (n = 2). This is the first study validating US service provision for GCA. Twenty-five US with a robust kappa on comparison with long-term diagnosis validates our service. A diagnosis of GCA should be made with extreme caution for US-/TAB- cases.Key Points• This is the first study offering a way to validate a new diagnostic US service by validation against TAB and long-term physician-verified diagnosis.• US has substantial to near-perfect agreement with long-term physician-verified diagnosis and is more reliable than TAB in our hands.• Alternative diagnoses should be sought in patients with dual negativity for US and TAB.
目前，尚无巨细胞动脉炎（GCA）诊断性超声（US）服务验证的机制。颞动脉活检（TAB）和分类标准是较差的基准。我们在 100 周（100wD）时根据医生验证的诊断对我们的服务进行了验证。25 名患者在开始泼尼松龙治疗的 7 天内进行了 US 检查，在 28 天内进行了 TAB 检查。使用 Cohen's kappa 将 US、TAB 和基线诊断（bD）与 100wD 进行比较。14 例 US 和 8 例 TAB 阳性。20 例基线和 14 例 100 周时诊断为 GCA。US 与 TAB 的kappa（95%CI）为 0.4（0.1，0.7）；US 与 bD 的 kappa 为 0.5（0.2，0.8）；TAB 与 bD 的 kappa 为 0.2（0.0，0.4）。与 100wD 相比，US 的 kappa（95%CI）为 0.8（0.6，1.0）；TAB 的 kappa 为 0.4（0.1，0.7）；bD 的 kappa 为 0.6（0.3，0.9）。7 例 US+/TAB-。有 4 例有其他确认：18FDG-PET（n=1）、CT 主动脉（n=1）和复发时的 US（n=2）。在 100 周时，4 例 bD 为 GCA 的病例（均为 US-/TAB-）有其他诊断，包括癌症（n=2）。这是第一项验证 US 服务提供用于 GCA 的研究。25 例 US 与长期诊断相比具有可靠的 kappa，验证了我们的服务。对于 US-/TAB-病例，应谨慎做出 GCA 诊断。
关键点
• 这是第一项通过与 TAB 和长期医生验证的诊断进行比较来验证新的诊断性 US 服务的研究。
• US 与长期医生验证的诊断具有实质性到近乎完美的一致性，在我们手中比 TAB 更可靠。
• 在 US 和 TAB 双重阴性的患者中应寻找其他诊断。
