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48. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC), 55. Jahrestagung der Österreichischen Gesellschaft für Plastische, Ästhetische und Rekonstruktive Chirurgie (ÖGPÄRC), 22. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen (VDÄPC)

14.09. - 16.09.2017, Graz, Österreich

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Temporal artery biopsy in the diagnosis of giant cell arteritis: size does not matter

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  • presenting/speaker Marios Papadakis - Helios Klinikum Wuppertal, Wuppertal, Deutschland
  • Sarantos Kaptanis - Homerton University Hospital NHS Foundation Trust, London, Vereinigtes Königreich
  • Aikaterini Kokkori-Steinbrecher - Helios Klinikum Wuppertal, Wuppertal, Deutschland
  • Philipp Holschneider - Helios Klinikum Wuppertal, Wuppertal, Deutschland
  • Gunnar Hübner - Helios Klinikum Wuppertal, Wuppertal, Deutschland

Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen. Österreichische Gesellschaft für Plastische, Ästhetische und Rekonstruktive Chirurgie. Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen. 48. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC), 55. Jahrestagung der Österreichischen Gesellschaft für Plastische, Ästhetische und Rekonstruktive Chirurgie, 22. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen (VDÄPC). Graz, Österreich, 14.-16.09.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. Doc159

doi: 10.3205/17dgpraec159, urn:nbn:de:0183-17dgpraec1597

Published: August 16, 2017

© 2017 Papadakis et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Background: Temporal artery biopsy (TAB), is a procedure commonly requested of plastic, general and vascular surgeons for the confirmation of the diagnosis of giant cell arteritis (GCA). The issue of the TAB specimen length has been discussed in the literature but remains controversial. We herein investigate the relationship between specimen length and positive TAB result in a tertiary-care hospital in Germany during a 8-year period. Secondarily, we studied the relationships of specific epidemiological and laboratory parameters with positive TABs.

Method: We retrospectively reviewed and analyzed the medical records of all patients suspicious for GCA, who underwent TAB from January 2009 to December 2016 in our institution.

Results/Discussion: The total sample consisted of 116 patients. Mean specimen length post-fixation was 0.94cm (0.49) whereas the other two dimensions had a mean length of 0.25cm (SD 0.19 and 0.09. The TAB(+) group consisted of 64 patients (55.2%), whereas 52 biopsies were negative for GCA (44.8%, TAB(-) group). The specimen length was comparable in the two groups (0.96cm vs 0.91cm, p=0.581). Twenty six TAB(+) patients (26/64, 41%) had a post-fixation specimen longer than 1cm, comparable with the respective percentage in the TAB(-) group (22/52, 42%, p=1). Mean ESR after the 1st hour was 60.5 (31.5) vs 44.6 (28.8) (p=0.006), while mean ESR after the 2nd hour was measured 77.3 (26.2) vs 64.5 (26.2) (p=0.015). Mean CRP was also significantly elevated in the TAB(+) group (5.53 vs 3.23mg/dl, p=0.049), although ESR elevation was higher, and platelet count was significantly lower in the TAB(-) group (297 vs 381, p=0.001). Logistic regression indicated that a five-variable model, consisting of age, specimen length post-fixation, ESR after the first hour, CRP and platelet count, can predict outcome in 70% of cases (compared to 55.2% in the null model). Multivariate regression showed that only platelet count kept statistically significant.

Conclusion: We conclude that there is no statistically significant association between longer TAB length and histological GCA diagnosis. There is no optimal length threshold predictive for GCA in order to avoid a false-negative GCA diagnosis.