What are the procedural details of temporal artery biopsy (TAB) for diagnosis of giant cell arteritis (GCA) (temporal arteritis)?

Updated: Sep 03, 2020
  • Author: Mythili Seetharaman, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

A systematic review of the TAB literature showed that the median positive yield of TAB was 25%, with interquartile range of 17% to 34%. [121]  Because of this high negative rate, and because there may be "skip lesions" with normal intervening segments of artery in GCA, some authors advocate obtaining 2- to 3-centimeter, and occasionally bilateral, TAB specimens. Surgeons should aim for the longest TAB length that is reasonably possible and compensate for possible shrinkage after fixation of the specimen. 

In the pathology literature, the recommended minimum length for fixed TAB specimens has varied. Different studies suggested fixed TAB length thresholds of 0.5 cm (n=1,520 biopsies), 0.7 cm (n=966 biopsies), or 1.5 cm (n=538 biopsies) as the optimum for identifying GCA and avoiding false-negative results. [122, 123, 124]  A review by Foster et al of 1190 TABs from 1163 patients suggests a 1.5–2.0 cm length as the optimal biopsy length for diagnosing GCA. This length accounts for post-fixation shrinkage. Longer lengths did not yield enough improvement in diagnosis to justify the increased risk of complications. [125, 126]

In the pathology literature, the recommended minimum length for fixed TAB specimens has varied. Different studies suggested fixed TAB length thresholds of 0.5 cm (n=1,520 biopsies), 0.7 cm (n=966 biopsies), or 1.5 cm (n=538 biopsies) as the optimum for identifying GCA and avoiding false-negative results. [117, 118, 119]

Clinicians who request TAB, but do not perform TAB themselves, may not appreciate the time required to harvest a TAB specimen, and may not appreciate that the length of the skin incision and biopsy specimen may not correspond, as the artery contracts when removed from the wound bed.

Biopsy of the most symptomatic side should be performed first. If frozen section is available, and the initial biopsy is negative, a contralateral specimen may be considered if clinical suspicion of GCA remains high. In cases in which a large TAB section is obtained from the most symptomatic side and multiple thin sections obtained, diagnosis can be made in 86% of cases with a unilateral TAB.


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