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M. R. Melson, L. A. Mawn; An Analysis of Patient Clinical and Laboratory Characteristics in Relation to Temporal Artery Biopsy Results. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4017.
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Clinical signs, symptoms and elevated serum inflammatory markers may support the diagnosis of giant cell arteritis (GCA), but a positive temporal artery biopsy (TAB) is often considered paramount in confirming it. Physicians must ultimately use clinical judgment in choosing patients on whom to perform TAB, but laboratory and other objective data may help support this decision. We examined our institutional experience over the past 10 years to help determine what patient characteristics were most associated with a positive TAB.
After institutional review board approval, we obtained the list of all patients at our institution that had undergone TAB from 1997-2008. Data on demographics, indications for TAB, relevant laboratory values, surgical service, biopsy specimen length, and biopsy results were collected from the patients’ charts. Data were analyzed to determine if there were significant differences in the clinical and laboratory characteristics of patients with different biopsy results.
Two hundred patients underwent TAB or ligation in the study period. Twenty-four patients were excluded for insufficient data or because the procedure was not performed to evaluate for GCA. Of the 176 biopsies included, 26 (15%) were positive and 154 (85%) were negative. The mean age of patients with a positive TAB was 74 and of those with negative biopsies, it was 68 (p=0.004). Among patients with positive TAB, 69% were female and 31% were male while the distribution for patients with a negative biopsy was 73% and 27%, respectively. The mean erythrocyte sedimentation rate (ESR) for patients with a positive biopsy was 82 mm/hr and that for patients with a negative biopsy was 60 mm/hr (p=0.0005). The average length of positive biopsy specimens was 2.8 cm and that for negative specimens was 3.3 cm (p=0.19).
Older age and higher sedimentation rates are correlated with a greater likelihood of a positive TAB in patients suspected of having GCA. Though more women undergo TAB, the proportion of men and women with positive biopsies is not significantly different. Longer TAB specimens were not correlated with a higher likelihood of a positive pathologic diagnosis.
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