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Variations in surgical technique of temporal artery biopsy (TAB) performed for diagnosis of giant cell arteritis (GCA) may contribute to high false-negative rates. This was a retrospective analysis of a large database that explored potential associations between specimen length and diagnostic sensitivity of TAB.
Histopathological reports and medical records of patients who underwent TAB in six hospitals between 2004 and 2009 were reviewed.
A total of 966 biopsies were analysed. The median postfixation specimen length was 1 (range 0·1-8·5) cm and 207 biopsies (21·4 per cent) were positive for GCA. Significant variation in prebiopsy erythrocyte sedimentation rate (ESR), arterial specimen length and positive results was noted amongst hospitals. Multivariable analysis revealed that patient age, ESR value and specimen length were independent predictors of GCA. Positive biopsies had significantly longer median specimen length compared with negative biopsies: 1·2 (range 0·3-8·5) versus 1·0 (0·2-8·0) cm respectively (P = 0·001). Receiver operating characteristic (ROC) analysis identified postfixation specimen length of at least 0·7 cm as the cut-off length with highest positive predictive value for a positive biopsy (area under ROC curve 0·574). Biopsies with specimen length of 0·7 cm or more had a significantly higher rate of positive results than smaller specimens (24·8 versus 12·9 per cent respectively; odds ratio 2·17, P = 0·001).
Specimen length and ESR were independent prognostic factors of a positive TAB result. A uniform referral practice and standard specimen length of approximately 1 cm could help eliminate discrepancies in the results of TAB. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Department of Surgery, Queen Elizabeth Hospital, King's Lynn, UK; Department of Surgery, Conquest Hospital, Hastings, UK. firstname.lastname@example.org.
This article was published in the following journal.
Name: The British journal of surgery
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Artery formed by the bifurcation of the BASILAR ARTERY. Branches of the posterior cerebral artery supply portions of the OCCIPITAL LOBE; PARIETAL LOBE; inferior temporal gyrus, brainstem, and CHOROID PLEXUS.
Arteries arising from the external carotid or the maxillary artery and distributing to the temporal region.
The technique of spraying a tissue specimen with a thin coat of a heavy metal such as platinum. The specimen is sprayed from an oblique angle, which results in the uneven deposition of the coating. The varying thicknesses create a shadow effect and give a three-dimensional appearance to the specimen.
A neurosurgical procedure that removes the anterior TEMPORAL LOBE including the medial temporal structures of CEREBRAL CORTEX; AMYGDALA; HIPPOCAMPUS; and the adjacent PARAHIPPOCAMPAL GYRUS. This procedure is generally used for the treatment of intractable temporal epilepsy (EPILEPSY, TEMPORAL LOBE).
Microscopy using an electron beam, instead of light, to visualize the sample, thereby allowing much greater magnification. The interactions of ELECTRONS with specimens are used to provide information about the fine structure of that specimen. In TRANSMISSION ELECTRON MICROSCOPY the reactions of the electrons that are transmitted through the specimen are imaged. In SCANNING ELECTRON MICROSCOPY an electron beam falls at a non-normal angle on the specimen and the image is derived from the reactions occurring above the plane of the specimen.