Abstract
Purpose :
Giant cell arteritis (GCA) is diagnosed based on a combination of signs, symptoms and laboratory evidence. Temporal artery biopsy is the gold standard in diagnosis of GCA and referral for biopsy is commonly encountered in ophthalmology practices. Our review investigates referral patterns from various medical specialties and the correlation to a positive biopsy. Additionally, we analyzed outcome trends among various departments performing biopsies over an eight-year period. To our knowledge, this series of 143 patients is the largest to date evaluating outcomes based on referral source and surgical trends among specialties.
Methods :
IRB approved retrospective chart review of 143 patients who underwent a temporal artery biopsy from January 2006 to April 2014 by all specialties at our tertiary care center.
Results :
Of 143 patients, 15 had positive biopsies (10.5%) and 128 had negative biopsies. The departments performing the biopsies primarily include ophthalmology, plastic surgery, and vascular surgery. Ophthalmology performed 109 (76.2%) biopsies; however, there was a significant decline over time. From 2006-2009, ophthalmology performed an average of 90.1% of the biopsies, which decreased to 54.6% from 2010-2013. Similarly, overall biopsies performed decreased from 22 biopsies in 2006 to 11 in 2013. Among the 15 positive biopsies, 11 (73.3%) were performed by ophthalmology, 3 (20%) by vascular surgery, and 1 (6.6%) by plastic surgery. Internal medicine accounted for the majority of the referrals (51%) followed by ophthalmology (18.2%), rheumatology (13.3%), neurology (10.5%), and others (7.0%). Neurology referrals resulted in a 20% positive biopsy rate, followed by rheumatology (15.8%) and internal medicine (12.3%). Ophthalmology referrals did not result in any positive biopsies. Of the 15 positive biopsies, 60% were referred from internal medicine, 20% from rheumatology, and 20% from neurology.
Conclusions :
Over time, we have witnessed a decrease in temporal artery biopsies, as well as a decline in the proportion of biopsies performed by the ophthalmology department. Internal medicine provided the largest referral base for temporal artery biopsies. However, neurology had the highest proportion of positive biopsies per referral, suggesting they may have a better pretest probability for the disease. Interestingly, none of the referrals from within the ophthalmology department resulted in a positive biopsy.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.