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Rheumatology 2005 44(Supplement 3):iii19-iii20; doi:10.1093/rheumatology/keh769
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Supplement Article

PP16. TEMPORAL ARTERY BIOPSY TO DIAGNOSE GIANT CELL ARTERITIS: THE LONGER, THE BETTER?

A. Mahr1, M. Saba1, M. Kambouchner2, M. Polivka3, M. Baudrimont4, I. Brochériou5, J. Coste6 and L. Guillevin1

1 Department of Internal Medicine, 6 Department of Biostatistics, Hôpital Cochin, Paris, France, 2 Department of Pathology, Hôpital Avicenne, Bobigny, France, 3 Department of Pathology, Hôpital Lariboisière, 4 Department of Pathology, Hôpital National des Quinze-Vingt, 5 Department of Pathology, Hôpital Pitié–Salpêtrière, Paris, France

Background: The optimal temporal artery biopsy (TAB) length yielding high diagnostic sensitivity for giant-cell arteritis (GCA) remains unknown.

Methods: We reviewed the histological TAB reports generated from 4 hospital pathology departments during defined periods with respect to demographics, histological findings and formalin-fixed TAB lengths. For bilateral TAB taken either simultaneously or sequentially within a 30-day interval, the individual sample lengths were added. A biopsy was considered positive for GCA based on the presence of a mononuclear cell infiltrate predominating at the media–intima junction or in the media.

Results: Among 1821 TAB histological reports reviewed, 287 (15.8%) were excluded because of missing data on the TAB length or birth date, sampling errors and/or age <50 yr. Mean TAB length of the ultimately analyzed 1520 data sets (67.2% females; mean age: 73.1±10.0 yr) was 1.33±0.73 cm. Histological evidence of GCA was found in 223 (14.7%) specimens, among which 164 (73.5%) contained giant cells. Statistical analyses including piecewise logistic regression identified 0.5 cm as the most pertinent TAB length change point in diagnostic sensitivity. Compared to TAB <0.5 cm, the respective odds ratios for positive TAB without and with multinucleated giant cells in samples ≥0.5-cm long were 5.7 (95% CI, 1.4–23.6) and 4.0 (0.97–16.5).

Conclusions: These findings suggest that fixed TAB at least 0.5-cm long could be sufficient to make a histological diagnosis of GCA. Although unlikely, the possibility of our results reflecting an indication bias cannot be excluded.


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