April 2010
Volume 51, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2010
Risk Factors Predictive of a Positive Temporal Artery Biopsy
Author Affiliations & Notes
  • K. T. Lewis
    Ophthalmology,
    University of Mississippi Medical Center, Jackson, Mississippi
  • K. Crowder
    Ophthalmology,
    University of Mississippi Medical Center, Jackson, Mississippi
  • W. Replogle
    Family Medicine,
    University of Mississippi Medical Center, Jackson, Mississippi
  • J. Fratkin
    Pathology,
    University of Mississippi Medical Center, Jackson, Mississippi
  • Footnotes
    Commercial Relationships  K.T. Lewis, None; K. Crowder, None; W. Replogle, None; J. Fratkin, None.
  • Footnotes
    Support  None.
Investigative Ophthalmology & Visual Science April 2010, Vol.51, 1457. doi:
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      K. T. Lewis, K. Crowder, W. Replogle, J. Fratkin; Risk Factors Predictive of a Positive Temporal Artery Biopsy. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1457.

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Abstract

Purpose: : To perform a comprehensive analysis of temporal artery biopsies performed at our institution over the past 10 years. We attempt to identify the most predictive clinical features, laboratory data, and demographics among those with biopsy positive Giant Cell Arteritis (GCA). Through statistical analysis of this data we hope to be able to better predict which patients will have a positive biopsy and eliminate many unnecessary biopsies.

Methods: : 153 Patients were identified using electronic health records, from whom were taken 195 temporal artery biopsies for suspected GCA between December, 1999 and March, 2009 at the University of Mississippi Medical Center in Jackson, MS. These patients were divided into biopsy positive and biopsy negative groups. Demographic characteristics, clinical features at presentation, laterality and length of biopsy, and laboratory data were compared between groups. Statistical analysis was then performed on this data.

Results: : 14 Biopsies from 13 patients were found to be positive for GCA. We found our rate of positive biopsies (7.2%) to be lower than previously published data (25-35%). We feel that this is likely due to our area’s racial demographic. Of the 13 patients with positive biopsies, 12 were Caucasian and 1 was African American supporting evidence for the low prevalence of the disease among the African American population (p=0.028). We also found a slight predilection of disease towards the female gender 11:2 (p=0.085). Increased age (p=0.026) and higher ESR (p=0.005) correlated significantly with positive biopsies. Bilateral biopsy yielded a slight increase in diagnostic yield over unilateral biopsy (9.5% vs 8.1% positive respectively). Longer length of biopsy segment showed no increase in diagnostic yield in our series. No relationship was found between CRP, platelets, or WBC and positive biopsies. Jaw claudication was found to have stronger predictive value for positive biopsy.

Conclusions: : Several criteria were identified that may be used to guide the clinician in their decision to perform a temporal artery biopsy in the case of suspected GCA. Caucasian race, increased age, and elevated ESR were found to have a significant positive correlation with biopsy positive GCA. Patients of female gender and patients with jaw claudication may have a higher incidence of GCA. The performance of bilateral biopsies improved diagnostic yield only minimally while the collection of longer biopsy specimens failed to show any significant diagnostic advantage in our series.

Keywords: vascular occlusion/vascular occlusive disease • clinical (human) or epidemiologic studies: risk factor assessment • neuro-ophthalmology: diagnosis 
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