Background/Purpose: Temporal arteritis or giant cell arteritis (GCA) is a large vessel vasculitis that involves extracranial arteries. Diagnosis requires a combination of clinical manifestations including symptoms of (scalp tenderness, claudication, visual disturbances), in the context of elevated inflammatory markers, in patients > 50 years of age. The gold standard of diagnosis continues to be a temporal artery biopsy. There is varying evidence regarding an ideal biopsy length, although current guidelines recommend at least 1 cm, with some evidence suggesting longer biopsies being ideal. The purpose of our study is to investigate whether biopsies performed in the province of Alberta, Canada are meeting guideline recommendations and whether different surgical subspecialties affect results of biopsies.

Methods: A retrospective chart review was performed on patients who had undergone a TAB procedure in 22 sites between January 1^st, 2008 to January 1^st, 2018. Data extracted included location of biopsy, post-fixation length, final pathological diagnoses and surgical subspecialty of individual performing biopsy. Predictors of positive pathology were modelled using logistic regression. Stata 14.1 (StataCorp) was used for data analysis.

Results: A total of 1203 biopsies were identified over the decade. Of these biopsies, we were able to identify the surgical specialist who performed the biopsy of 1003 biopsies. General surgery performed 428 (70 positive [16.36%]) positive biopsies with median length of 1 cm (QR, 0.7 – 1.5), Ophthalmology performed 393 (100 positive [25.45%]) biopsies with median length of 1.6 cm (QR, 1.2 – 2.1), Plastic Surgery  performed 162 (28 positive [17.28%]) biopsies with median length of 1.2 cm (QR, 0.8 – 1.7), Otolaryngology performed nine (one positive [11.11%]) biopsies with median length of 1.3 cm (QR, 0.3 – 1.5), Vascular Surgery performed eight (one positive [12.50%]) biopsies with median length of 3 cm (QR, 1.85 – 3.35), Family Medicine surgical assistants performed two (zero positive [0%]) biopsies with median length of 0.825 cm (QR, 0.65 – 1) and Neurosurgery performed one biopsy at 0.8 cm, which was negative for GCA. Univariate analysis noted ophthalmology as the only surgical subspecialty that was associated with positive GCA diagnosis with OR 1.74, 95% CI, 1.24 – 2.46; p = 0.001. We found that of the 22 sites who performed at least 31 biopsies, median lengths ranged between 0.8 cm to 2.2 cm.

Conclusion: This analysis evaluated the various surgical specialties who complete temporal artery biopsies. The surgical specialty with the highest yield of positive temporal artery biopsies was Ophthalmology, who perform the longest biopsies amongst surgical subspecialties and has the highest positive yield for a GCA diagnosis. Our study also indicates there are institutions in the province of Alberta who consistently do not meet the one cm biopsy length recommendations. This baseline data will inform further practice management for optimal biopsy lengths.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/temporal-artery-biopsy-lengths-in-alberta-which-surgical-subspecialty-achieves-optimal-biopsy-lengths/