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Role of Temporal artery biopsy in a sequential Giant Cell Arteritis fast-track pathway: a 5-year prospective study

Eye volume 37, pages 1614–1618 (2023)Cite this article

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Abstract

Background

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.

Methods

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.

Results

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).

Conclusion

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.

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Data availability

We would be happy to provide de-identified participant data if needed, at the time of publication, including the statistical analysis plan.

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Acknowledgements

The authors would like to acknowledge Carl Tiivas for his contribution. There are no funding sources to declare for any author. This data was presented at: 1. European League Against Rheumatism (EULAR) Annual European Congress of Rheumatology, 3–5th June 2020, 2. 10th Kettering Eye Meeting, 11th September 2020, Kettering (won first prize for oral presentation) 3. Midlands Ophthalmological Society annual meeting, 2nd October 2020, Birmingham.

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Author notes

  1. Shirish Dubey

    Present address: Oxford University Hospitals NHS Foundation Trust, Oxford, UK

Authors and Affiliations

  1. Department of Ophthalmology, University Hospital Coventry & Warwickshire NHS Trust, Coventry, UK

    Anshu Sachdev, Matthew George & Purnima Mehta

  2. Department of Rheumatology, University Hospital Coventry & Warwickshire NHS Trust, Coventry, UK

    Shirish Dubey

  3. Department of Mathematics, Durham University, Durham, UK

    Richard Crossman

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  1. Anshu Sachdev
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Contributions

All listed authors provided substantial contributions to this work. PM, AS, and MG were involved with the conception and study design. SD contributed to study design and ethical approval. The literature review was led by AS with help from PM. RC provided detailed statistical analysis. All authors have contributed to the critical revision of the manuscript and agreed on the final version.

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Correspondence to Purnima Mehta.

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Sachdev, A., Dubey, S., George, M. et al. Role of Temporal artery biopsy in a sequential Giant Cell Arteritis fast-track pathway: a 5-year prospective study. Eye 37, 1614–1618 (2023). https://doi.org/10.1038/s41433-022-02132-0

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