Low diagnostic yield with second biopsies in suspected giant cell arteritis

Objectives: The clinical diagnosis of giant cell arteritis may be confirmed with a biopsy of the superficial temporal artery. Because of "skip lesions ," a histologic diagnosis of giant cell arteritis may be missed with a unil ateral biopsy. The authors report a study that investigates whether a biops y of the contralateral superficial temporal artery provides any additional information For confirmation of a diagnosis of giant cell arteritis. Methods: Available medical records of 91 consecutive patients who underwent bilateral superficial temporal artery biopsy procedures were reviewed. inf ormation that was abstracted included sequence of biopsy procedures, length specimens, and histologic diagnosis. Microslides from all biopsy specimens were retrieved and reexamined in a masked fashion by the ocular pathologis t (RCE) who had made the original diagnoses. Results: Seventy-two bilateral simultaneous superficial temporal artery bio psies and 19 bilateral sequential biopsies were performed. The mean length of biopsy specimens was 23 mm, and the mean length of the total artery remo ved from each patient was 33 mm. The pathologist's original diagnosis and t he diagnosis at reexamination were in 100% agreement. In 90 (99%) of the 91 patients, the histologic diagnoses in the left and right superficial tempo ral arteries were the same. This is a concordance rate of 98.9% (38 of 39 p ositive biopsy results) among the positive biopsy results. Conclusion: There is a low yield of information from a second temporal arte ry biopsy in patients with suspected giant cell arteritis. This suggests th at patients who present to the ophthalmologist with possible giant cell art eritis will, in most cases, have a similar diagnosis on both temporal arter y biopsies if the specimens are adequate.