Division of Rheumatology, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey.
Vasculitis Research Centre, Hacettepe University, Ankara, Turkey.
Rheumatol Int. 2024 Nov;44(11):2547-2554. doi: 10.1007/s00296-024-05708-z. Epub 2024 Sep 8.
Histopathological findings associated with definite vasculitis in temporal artery biopsy (TAB) defined in 2022 ACR/EULAR classification criteria for Giant Cell Arteritis (GCA) was published in 2022. We aimed to evaluate the TAB of our GCA patients for histopathological findings associated with definite vasculitis. Patients who were diagnosed with GCA by clinicians and underwent TAB between January 2012 and May 2022 were included. Hospital electronic records and patients' files were reviewed retrospectively. A total of 90 patients' pathology reports were evaluated by a pathologist and a rheumatologist. In cases where microscopic findings were not specified in the pathology reports, histopathologic specimens were re-evaluated (n = 36). A standard checklist was used for histopathological findings of definite vasculitis. Patients were divided into two groups; (i) definite vasculitis-GCA and (ii) non-definite-GCA group, and the clinical and demographic characteristics for all patients were compared. The mean age of patients was 69.8 (± 8.5) years and 52.2% were female. In the first evaluation, 66 (73.3%) patients had a diagnosis of vasculitis according to pathology reports. In the re-evaluation of biopsy specimens, at least one definite finding of vasculitis was observed in TAB of 10/24 (41.6%) patients whose microscopic findings were not specified in the pathology reports. The ROC analysis showed that biopsy length had diagnostic value in predicting the diagnosis of definite vasculitis (AUC: 0.778, 95% CI: 0.65-0.89, p < 0.001). In those with a biopsy length of ≥ 1 cm, sensitivity was 76.5%, specificity was 64.3%, and PPV value was 92. In multivariate analysis, the most significant factor associated with definite vasculitis was biopsy length (OR: 1.18 (1.06-1.31), p = 0.002). Microscopic findings were reported in over 70% of patients. Reinterpretation of results according to a standard check-list improved the impact of TAB in the diagnosis of GCA. A biopsy length ≥ 1 cm was found to contribute towards a definitive histopathological vasculitis diagnosis.
2022 年，ACR/EULAR 巨细胞动脉炎（GCA）分类标准中定义了与颞动脉活检（TAB）中明确血管炎相关的组织病理学发现。我们旨在评估我们的 GCA 患者的 TAB 是否存在与明确血管炎相关的组织病理学发现。纳入 2012 年 1 月至 2022 年 5 月期间经临床医生诊断为 GCA 并接受 TAB 的患者。回顾性查阅医院电子病历和患者档案。由一名病理学家和一名风湿病学家评估了 90 名患者的病理报告。在病理报告中未具体说明微观发现的情况下，重新评估了组织病理学标本（n=36）。使用标准检查表评估明确血管炎的组织病理学发现。将患者分为两组；（i）明确血管炎-GCA 组和（ii）非明确-GCA 组，并比较所有患者的临床和人口统计学特征。患者的平均年龄为 69.8（±8.5）岁，52.2%为女性。在第一次评估中，根据病理报告，66（73.3%）例患者诊断为血管炎。在对活检标本的重新评估中，在 24 例（41.6%）病理报告中未具体说明微观发现的患者的 TAB 中观察到至少一个明确的血管炎发现。ROC 分析表明，活检长度对预测明确血管炎的诊断具有诊断价值（AUC：0.778，95%CI：0.65-0.89，p<0.001）。在活检长度≥1cm 的患者中，敏感性为 76.5%，特异性为 64.3%，PPV 值为 92%。多变量分析显示，与明确血管炎最相关的因素是活检长度（OR：1.18（1.06-1.31），p=0.002）。超过 70%的患者报告了微观发现。根据标准检查表重新解释结果提高了 TAB 在 GCA 诊断中的作用。发现活检长度≥1cm 有助于明确组织病理学血管炎的诊断。
