Biopsy Negative Temporal Arteries.
Anne M Bartlett, Cynthia T Welsh. Medical University of South Carolina, Charleston
Background: Giant cell arteritis is the most common form of systemic vasculitis in older adults. The major therapy, prednisone, holds more risk for this age group even than it does in younger patients. The alternative, however, can be permanent visual loss. The literature indicates a range in negative biopsies up to 2/3. Our impression has been that of a much higher negative rate at our institution.
Design: We conducted a retrospective review of all temporal artery biopsies from 1995 to 2010 to determine the actual positive rate, related differences in biopsy material, and any possible clinical associations.
Results: Temporal artery biopsies from 1995 to 2010 numbered 244 total, with 19 displaying active inflammatory infiltrates (8%), 10 demonstrating medial scars (4%) consistent with prior injury to the artery (possibly treated arteritis, and 20 with adventitial perivascular lymphocytic cuffing. Bilateral biopsies were done simultaneously in 99 patients, with both active in 7 (7%), and both negative in 84 (85%). Activity was seen in only one of the two biopsies in 2 patients (2%), and medial scarring in one of two biopsies in two patients (2%). Two patients were biopsied twice with a medial scar in only one of the two (1%), and medial scar followed by active arteritis in 1 (1%). Length of biopsy was surgeon dependent; half the active arteritis biopsies were less than 1.5 cm and half greater than 2 cm. The biopsies containing medial scars were all over 2.7 cm. Biopsies which did not show histologic evidence of activity tended to be larger in general, presumably due to the surgical impression of a lack of focal nodularity.
Conclusions: Only 8% showed active signs of arteritis, and 4% demonstrated medial scars consistent with prior injury suggesting treated arteritis. Even combined, this is still only 12% of biopsies with any suggestion of arteritis, which is considerably lower than reported in the literature. Larger biopsies were no more likely to show active inflammatory changes than quite small biopsies, but medial scars tended to be picked up on larger biopsies. This would tend to indicate that surgeons can intra-operatively identify grossly active lesions. We will compare and contrast the clinical features of the patients with positive and negative biopsies to explain the discrepant rates at which these patients are being referred for biopsy.
Wednesday, March 2, 2011 1:00 PM
Poster Session VI # 290, Wednesday Afternoon