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. 2000 Feb;53(2):131–136. doi: 10.1136/jcp.53.2.131

Temporal artery biopsy: is there any value in examining biopsies at multiple levels?

A Chakrabarty 1, A Franks 1
PMCID: PMC1763285  PMID: 10767829

Abstract

Aims—To analyse the cost-effectiveness of three strategies for examining temporal artery biopsies based on data from cases examined over the past 10 years.

Methods—Of a total of 172 temporal artery biopsies, five were unsuitable for further analysis, 47 had already had levels cut, and 120 had levels cut as part of the study. All the biopsies were examined blind before and after levels. A tree with eventual diagnostic outcomes for different strategies was constructed and economic and sensitivity analyses performed. Welcan units were used to assess technical workload.

Results—Only one of the 132 initially normal cases and two of 14 diagnosed with periarterial lymphocytic infiltration (PALI) revealed giant cell arteritis after examining the tissue at multiple levels. Fifteen cases (8.9%) showed PALI not previously observed. The marginal cost for each extra case of giant cell arteritis detected was 83.5 Welcan units for a strategy of routine levels on all sections, and 21 Welcan units for a strategy of only cutting levels if PALI was present on the initial section. These costs were sensitive to the frequency of giant cell arteritis in cases with PALI and to the relative extra cost of moving from cutting single section to routine levels.

Conclusions—Routinely examining a temporal artery biopsy at multiple levels does not increase the diagnostic yield of the test, although selective further examination may be indicated in some cases. The significance of PALI is uncertain. The cost-benefit of the different strategies in terms of clinical decision making revolve around the perceived risk inherent in not making a diagnosis of giant cell arteritis.

Key Words: temporal artery biopsy • economic analysis • decision analysis

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Figure 1 Giant cell arteritis characterised by dense lymphocytic infiltration and multinucleated giant cells. (Haematoxylin and eosin.)

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Figure 2 Temporal artery with a focus of lymphocytic infiltration around a periarterial venule. (Haematoxylin and eosin.)

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Figure 3 Temporal artery with calcification of the elastic lamina (arrow) and a focus of periarterial lymphocytic infiltration. (Haematoxylin and eosin.)

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Figure 4 Diagnostic pathway of cases under study. GCA, giant cell arteritis; PALI, periarterial lymphocytic infiltration.

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Figure 5 Structure of economic model. GCA, giant cell arteritis; PALI, periarterial lymphocytic infiltration.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Achkar A. A., Lie J. T., Hunder G. G., O'Fallon W. M., Gabriel S. E. How does previous corticosteroid treatment affect the biopsy findings in giant cell (temporal) arteritis? Ann Intern Med. 1994 Jun 15;120(12):987–992. doi: 10.7326/0003-4819-120-12-199406150-00003. [DOI] [PubMed] [Google Scholar]
  2. Albert D. M., Ruchman M. C., Keltner J. L. Skip areas in temporal arteritis. Arch Ophthalmol. 1976 Dec;94(12):2072–2077. doi: 10.1001/archopht.1976.03910040732006. [DOI] [PubMed] [Google Scholar]
  3. Allison M. C., Gallagher P. J. Temporal artery biopsy and corticosteroid treatment. Ann Rheum Dis. 1984 Jun;43(3):416–417. doi: 10.1136/ard.43.3.416. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Allsop C. J., Gallagher P. J. Temporal artery biopsy in giant-cell arteritis. A reappraisal. Am J Surg Pathol. 1981 Jun;5(4):317–323. doi: 10.1097/00000478-198106000-00001. [DOI] [PubMed] [Google Scholar]
  5. Baldursson O., Steinsson K., Björnsson J., Lie J. T. Giant cell arteritis in Iceland. An epidemiologic and histopathologic analysis. Arthritis Rheum. 1994 Jul;37(7):1007–1012. doi: 10.1002/art.1780370705. [DOI] [PubMed] [Google Scholar]
  6. Buchbinder R., Detsky A. S. Management of suspected giant cell arteritis: a decision analysis. J Rheumatol. 1992 Aug;19(8):1220–1228. [PubMed] [Google Scholar]
  7. Disdier P., Pellissier J. F., Harle J. R., Figarella-Branger D., Bolla G., Weiller P. J. Significance of isolated vasculitis of the vasa vasorum on temporal artery biopsy. J Rheumatol. 1994 Feb;21(2):258–260. [PubMed] [Google Scholar]
  8. Fernandez-Herlihy L. Temporal arteritis: clinical aids to diagnosis. J Rheumatol. 1988 Dec;15(12):1797–1801. [PubMed] [Google Scholar]
  9. Hall S., Persellin S., Lie J. T., O'Brien P. C., Kurland L. T., Hunder G. G. The therapeutic impact of temporal artery biopsy. Lancet. 1983 Nov 26;2(8361):1217–1220. doi: 10.1016/s0140-6736(83)91269-2. [DOI] [PubMed] [Google Scholar]
  10. Klein R. G., Campbell R. J., Hunder G. G., Carney J. A. Skip lesions in temporal arteritis. Mayo Clin Proc. 1976 Aug;51(8):504–510. [PubMed] [Google Scholar]
  11. Mambo N. C. Temporal (granulomatous) arteritis: a histopathological study of 32 cases. Histopathology. 1979 May;3(3):209–221. doi: 10.1111/j.1365-2559.1979.tb02998.x. [DOI] [PubMed] [Google Scholar]
  12. McDonnell P. J., Moore G. W., Miller N. R., Hutchins G. M., Green W. R. Temporal arteritis. A clinicopathologic study. Ophthalmology. 1986 Apr;93(4):518–530. doi: 10.1016/s0161-6420(86)33706-0. [DOI] [PubMed] [Google Scholar]
  13. Nadeau S. E. Temporal arteritis: a decision-analytic approach to temporal artery biopsy. Acta Neurol Scand. 1988 Aug;78(2):90–100. doi: 10.1111/j.1600-0404.1988.tb03627.x. [DOI] [PubMed] [Google Scholar]
  14. Nitecki S., Kopelman D., Schein M., Hashmonai M. [Temporal artery biopsy--required or superfluous?]. Harefuah. 1993 Mar 15;124(6):333-6, 391. [PubMed] [Google Scholar]
  15. Ponge T., Barrier J. H., Grolleau J. Y., Ponge A., Vlasak A. M., Cottin S. The efficacy of selective unilateral temporal artery biopsy versus bilateral biopsies for diagnosis of giant cell arteritis. J Rheumatol. 1988 Jun;15(6):997–1000. [PubMed] [Google Scholar]
  16. Rich N. M. Temporal arteritis. Otolaryngol Clin North Am. 1982 Aug;15(3):693–698. [PubMed] [Google Scholar]
  17. Robb-Nicholson C., Chang R. W., Anderson S., Roberts W. N., Longtine J., Corson J., Larson M., George D., Green J., Bryant G. Diagnostic value of the history and examination in giant cell arteritis: a clinical pathological study of 81 temporal artery biopsies. J Rheumatol. 1988 Dec;15(12):1793–1796. [PubMed] [Google Scholar]
  18. Sudlow C. Diagnosing and managing polymyalgia rheumatica and temporal arteritis. Sensitivity of temporal artery biopsy varies with biopsy length and sectioning strategy. BMJ. 1997 Aug 30;315(7107):549–549. [PMC free article] [PubMed] [Google Scholar]
  19. Swannell A. J. Polymyalgia rheumatica and temporal arteritis: diagnosis and management. BMJ. 1997 May 3;314(7090):1329–1332. doi: 10.1136/bmj.314.7090.1329. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Vilaseca J., González A., Cid M. C., Lopez-Vivancos J., Ortega A. Clinical usefulness of temporal artery biopsy. Ann Rheum Dis. 1987 Apr;46(4):282–285. doi: 10.1136/ard.46.4.282. [DOI] [PMC free article] [PubMed] [Google Scholar]

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