Department of Ophthalmology, University Hospital Coventry & Warwickshire NHS Trust, Coventry, UK.
Department of Rheumatology, University Hospital Coventry & Warwickshire NHS Trust, Coventry, UK.
Eye (Lond). 2023 Jun;37(8):1614-1618. doi: 10.1038/s41433-022-02132-0. Epub 2022 Aug 10.
Increasing number of centres are establishing sequential fast track pathways (FTP) for management of giant cell arteritis (GCA), with temporal artery ultrasound (US) replacing temporal artery biopsy (TAB) as the first investigational method. Biopsy is performed as second investigation, when US is negative/inconclusive. This study investigates the role of TAB in a sequential GCA-FTP and its utility in those with negative/inconclusive US.
Prospective study of patients referred for TAB as part of Coventry sequential GCA-FTP May 2014-June 2019. Analysis included sensitivity and specificity of TAB, impact of arterial specimen length and duration of treatment with corticosteroids on sensitivity of TAB and the clinical predictors for a positive biopsy.
A total of 1149 patients with suspected GCA were referred to this GCA-FTP, with 109 (9.5%) referred for TAB. Overall sensitivity of TAB was 47% (specificity: 100%) and in patients with negative/inconclusive US sensitivity was 39% (specificity:100%). Post-fixation arterial specimen length <15 mm showed lower sensitivity (14%), which increased to 52% when specimen length was ≥15 mm. Sensitivity of TAB was highest in first 7 (60%) to 10 days (59%) from starting corticosteroids. Predictors of positive biopsy using univariate logistic regression analysis were jaw claudication (OR = 5.40; p = 0.0057), elevated erythrocyte sedimentation rate (OR = 5.50; p = 0.013) and elevated C-reactive protein (OR = 23.7; p = 0.0043).
This is the first study to look at the role of TAB in a sequential GCA-FTP. Biopsy plays an important role in GCA-FTP, when US is negative/inconclusive. Sensitivity of TAB improved when specimen length was ≥15 mm and performed within 10 days of commencing corticosteroids.
越来越多的中心正在建立巨细胞动脉炎（GCA）的连续快速通道（FTP），将颞动脉超声（US）取代颞动脉活检（TAB）作为第一种检查方法。当 US 结果阴性/不确定时，进行活检作为第二种检查。本研究调查了 TAB 在连续 GCA-FTP 中的作用及其在 US 结果阴性/不确定时的效用。
这是一项前瞻性研究，研究对象为 2014 年 5 月至 2019 年 6 月期间因 TAB 而被转诊至考文垂连续 GCA-FTP 的患者。分析包括 TAB 的敏感性和特异性、动脉标本长度和皮质类固醇治疗时间对 TAB 敏感性的影响，以及活检阳性的临床预测因素。
共有 1149 例疑似 GCA 的患者被转诊至该 GCA-FTP，其中 109 例（9.5%）因 TAB 而被转诊。TAB 的总体敏感性为 47%（特异性：100%），在 US 结果阴性/不确定的患者中，敏感性为 39%（特异性：100%）。固定后动脉标本长度<15mm 显示出较低的敏感性（14%），当标本长度≥15mm 时敏感性增加至 52%。从开始使用皮质类固醇的第 7 天（60%）至第 10 天（59%），TAB 的敏感性最高。使用单变量逻辑回归分析的活检阳性预测因素包括下颌运动障碍（OR=5.40；p=0.0057）、红细胞沉降率升高（OR=5.50；p=0.013）和 C 反应蛋白升高（OR=23.7；p=0.0043）。
这是第一项研究在连续 GCA-FTP 中观察 TAB 作用的研究。当 US 结果阴性/不确定时，活检在 GCA-FTP 中起着重要作用。当标本长度≥15mm 且在开始使用皮质类固醇后 10 天内进行时，TAB 的敏感性提高。
