Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Department of General Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
J Vasc Surg. 2022 Dec;76(6):1704-1709. doi: 10.1016/j.jvs.2022.04.043. Epub 2022 Jun 13.
A surgical temporal artery biopsy (TAB) is the gold standard for diagnosis of giant cell arteritis (GCA). The necessity of performing a bilateral biopsy remains under debate. The primary objective of this study was to assess the rate of discordance between pathology results in patients who underwent bilateral TAB for suspected GCA.
We performed a retrospective review of patients who underwent bilateral TAB for the diagnosis of GCA between 2011 and 2020. The primary end point was the rate of discordance between specimens for patients with pathology positive GCA. Secondary end points included assessments of the sensitivity of preoperative temporal artery duplex and the effects of specimen length and specialty of referring provider on the diagnostic yield of the biopsy.
During the study period, 310 patients underwent bilateral TAB for the diagnosis of GCA. These patients were primarily female (73.9%), elderly (mean age, 70.8 years), and Caucasian (95.8%). Preoperative symptoms for patients were typically bilateral (59%) and included headache (81%), vision changes (45.2%), and temporal tenderness (32.6%). Most patients (85.2%) were on preoperative steroid therapy at the time of surgical biopsy with a mean preoperative duration of steroid therapy of 15.1 days. Overall, 91 patients (29.4%) had a positive pathologic diagnosis after bilateral TAB. Of these patients, 11 had a positive pathology result in only a single specimen, resulting in a discordance rate of 12.1%. Preoperative temporal artery duplex demonstrated a low sensitivity (27.3%) for identifying patients with pathologic positive disease. There were no significant differences between the pathology-positive and -negative patients in terms of mean surgical specimen length (1.67 cm vs 1.64 cm; P = .67) or the specialty of the referring provider (P = .73).
At our institution, we observed a 12.1% discordance rate between pathology results in patients who underwent bilateral TAB for diagnosis of GCA. A preoperative temporal artery duplex provided little value in identifying patients with biopsy-proven GCA.
外科颞动脉活检（TAB）是诊断巨细胞动脉炎（GCA）的金标准。对双侧活检的必要性仍存在争议。本研究的主要目的是评估在疑似 GCA 患者中进行双侧 TAB 后病理结果不一致的发生率。
我们对 2011 年至 2020 年间进行双侧 TAB 以诊断 GCA 的患者进行了回顾性研究。主要终点是病理阳性 GCA 患者的标本之间不一致的发生率。次要终点包括术前颞动脉双功超声的敏感性评估，以及标本长度和转诊医生专业对活检诊断率的影响。
在研究期间，310 例患者因诊断 GCA 而行双侧 TAB。这些患者主要为女性（73.9%）、老年人（平均年龄 70.8 岁）和白人（95.8%）。患者的术前症状通常为双侧（59%），包括头痛（81%）、视力改变（45.2%）和颞部压痛（32.6%）。大多数患者（85.2%）在手术活检时正在接受术前皮质类固醇治疗，平均术前皮质类固醇治疗时间为 15.1 天。总体而言，91 例患者（29.4%）双侧 TAB 后病理诊断阳性。其中 11 例患者仅在单个标本中出现阳性病理结果，不一致率为 12.1%。术前颞动脉双功超声对识别病理阳性疾病患者的敏感性较低（27.3%）。在平均手术标本长度（1.67cm 比 1.64cm；P=0.67）或转诊医生的专业（P=0.73）方面，阳性和阴性患者之间无显著差异。
在我们的机构中，我们观察到在双侧 TAB 诊断 GCA 的患者中，病理结果的不一致率为 12.1%。术前颞动脉双功超声对识别活检证实的 GCA 患者几乎没有价值。
