Increased Volume Of Temporal Artery Duplex Over Time With Stable Biopsy Volume
Skylar Nahi, BA1, Matthew Chia, MD MS2, Anisha Dua, MD MPH2, Heron Rodriguez, MD2.
1Feinberg School of Medicine Northwestern University, Chicago, IL, USA, 2Northwestern Medicine, Dept of Vascular Surgery, Chicago, IL, USA.
Abstract:
OBJECTIVE:Giant cell arteritis (GCA) is a systemic, inflammatory vasculitis with relatively low incidence but a substantial risk of permanent vision loss if untreated. The current treatment paradigm as recommended by the American College of Rheumatology is to initiate oral glucocorticoids in patients with suspected GCA and pursue unilateral, long-segment biopsy within 2 weeks. The role of temporal artery duplex for diagnosis of GCA remains unclear. The aim of this study was to evaluate trends in use of temporal artery duplex over time, and to compare concordance between duplex and biopsy results.
METHODS:This study was a single center, retrospective study of all patients from 2010 - 2021 undergoing temporal artery duplex or temporal artery biopsy. Patients were identified from the institutional enterprise data warehouse using current procedure terminology codes. Patient characteristics were compared with standard bivariate methods, while volume time was evaluated with nonparametic test for trend.
RESULTS:A total of 525 patients met study criteria, of which 381 underwent a temporal artery duplex and 258 underwent temporal artery biopsy. There was no trend in biopsy volume (p = 0.35), but the volume of temporal artery duplexes increased significantly over the study period (p = 0.001, Figure 1). Despite the increase in duplex volume, there was no trend in positivity rate of temporal arteritis by either duplex (p = 0.39) or pathologic diagnosis (p = 0.42). In our cohort, 114 patients underwent both duplex and biopsy and 246 patients with negative temporal artery duplex did not undergo surgical biopsy following their duplex.
CONCLUSIONS:The volume of temporal artery duplex ordering increased over the study period, without a concomitant increase in the diagnosis of suspected giant cell arteritis. Although temporal artery duplex demonstrated high sensitivity and specificity for pathologic findings of temporal arteritis, there was a high volume of patients with negative duplex who did not undergo biopsy. These data may represent an opportunity to improve diagnostic workup of GCA.
FIGURE: Trends in Performance of Temporal Artery Duplex and Biopsy from 2010 to 2021. 
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