Article Text

PDF
THU0302 Histology findings in giant cell arteritis (GCA) and their relationship with the ultrasound results: analysis of data from the tabul study (temporal artery biopsy vs ultrasound in diagnosis of giant cell arteritis)
  1. CB Ponte1,2,
  2. S Monti3,
  3. S Singh4,
  4. A Hutchings5,
  5. A Diamantopoulos6,
  6. B Dasgupta7,
  7. WA Schmidt8,
  8. RA Luqmani9
  1. 1Department of Rheumatology, Hospital de Santa Maria
  2. 2Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
  3. 3Department of Rheumatology, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy
  4. 4Nuffield Department of Surgical Sciences, University of Oxford, Oxford
  5. 5Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
  6. 6Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway
  7. 7Department of Rheumatology, Southend University Hospital, NHS Foundation Trust, Southend-on-Sea, United Kingdom
  8. 8Department of Rheumatology, Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany
  9. 9Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom

Abstract

Background Although temporal artery biopsy (TAB) has been the gold standard for diagnosis of GCA, ultrasound has superior sensitivity but lower specificity. Occasionally, histological evidence of inflammation is restricted to the vasa vasorum, the periadventitial small vessels, or both, which could limit the diagnostic sensitivity of ultrasound for GCA. Moreover, false positive ultrasound results have been described in patients with arteriosclerosis on histology.

Objectives To compare histologic findings with ultrasound results from patients with suspected GCA included in the TABUL study (a multinational study to assess the relative performance of ultrasound and TAB for diagnosing GCA).

Methods All patients with newly suspected GCA underwent an ultrasound of both temporal and axillary arteries, followed by a TAB, within 7 days of commencing glucocorticoid therapy. TAB pathological diagnoses were analysed and the different histologic features were compared with the ultrasound results using Chi-square or Fisher exact tests.

Results Results for TAB and ultrasound were available in 388 patients (69% with a final clinician's diagnosis of GCA). An artery was definitely obtained in 363 (94%) TABs; the pathological diagnosis was GCA in 104 (29%) cases, arteriosclerosis in 35 (10%), normal in 203 (56%) and other conditions in 21 (6%). All TABs compatible with GCA also had a final clinician's diagnosis of GCA (73% with positive ultrasound). Table 1 shows that ultrasound positivity occurred more frequently in patients where the media was the predominant site of inflammation (p=0.01). The ultrasound result was positive in 9 (26%) cases where TAB was consistent with arteriosclerosis, 8 (89%) of whom had a final clinician's diagnosis of GCA. The ultrasound was positive in 64 (32%) cases where TAB was normal, 52 (81%) of whom had a final clinician's diagnosis of GCA.

Conclusions Amongst patients with suspected GCA, ultrasound is more likely to be positive when histological inflammation is predominantly present in the intima-media. No significant correlation between histologic findings and negative ultrasound results was found, but the small number of cases with predominant vasa vasorum infiltrates in our cohort limited this analysis. There was only one false positive ultrasound in patients with arteriosclerosis on TAB.

Disclosure of Interest None declared

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.