There Are No Reliable Predictors of Pathologically Positive Temporal Artery Biopsy
Seth J. Concors, MD, Julia D. Glaser, MD, Loren Mead, BA, Abhinay Ramachandran, BA, Scott Damrauer, MD, Grace Wang, MD, Venkat Kalapatapu, MD, Michael Golden, MD, Benjamin Jackson, MD, Ronald Fairman, MD, Paul J. Foley, III, MD.
University of Pennsylvania, Philadelphia, PA, USA.
Objective: Temporal arteritis (TA) can present with a wide spectrum of symptoms, including temporal headaches, abrupt vision changes, jaw or tongue claudication, fevers, and elevated serum inflammatory markers. Workup for TA involves measurement of inflammatory blood makers, and a surgical temporal artery biopsy (TABx). Several factors affect the diagnostic yield of TABx, including whether a bilateral biopsy has been performed and the length of the obtained specimen. Multiple patient-specific factors have been identified in small series that raise the diagnostic suspicion for TA, including demographic features, the cluster of symptoms, and serum inflammatory markers. Here, we review our large series of patients who have undergone a temporal artery biopsy.
Methods: Preoperative, intraoperative, and postoperative records for patients that underwent a temporal artery biopsy in our health system from 1998 to 2017 were retrospectively reviewed.
Results: A total of 133 patients were included. 21 patients had a positive pathologic diagnosis of TA, and 112 were negative. Univariate analysis (Table 1), identified elevated platelet count, bilateral scalp tenderness, and tongue claudication at the time of TABx as associated with a positive pathologic diagnosis. Age, BMI, race, specimen length, administration of steroids/aspirin or the presence of a rheumatologic condition were not associated with a positive TABx. In a multivariate analysis, only jaw claudication was significantly associate with the diagnosis of TA, OR 4.48 (95% CI 1.06-18.83, p<0.05); however, only 2.7% of patients presented with this symptom. No post-operative complications were noted.
Conclusions: TABx is a low morbidity procedure, and there are no reliable clinical predictors of positive pathology. Therefore, this procedure should always be performed when the diagnosis of TA is entertained clinically.
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