Temporal Artery Biopsy for Diagnosing Giant Cell Arteritis: A Ten-year Review


Purpose: To assess the use of temporal artery biopsy (TAB) in diagnosing giant cell arteritis (GCA) and to evaluate patients’ clinical and laboratory characteristics.

Methods: We conducted a retrospective chart review of patients with suspected GCA who underwent TAB and had complete workup in a tertiary center in Iran between 2008 and 2017. The 2016 American College of Rheumatology (ACR) revised criteria for early diagnosis of GCA were used for each patient for inclusion in this study.

Results: The mean age of the 114 patients in this study was 65.54 ± 10.17 years. The mean overall score according to the 2016 ACR revised criteria was 4.17 ± 1.39, with 5.82 ± 1.28 for positive biopsies and 3.88 ± 1.19 for negative biopsies (p <0.001). Seventeen patients (14.9%) had a positive biopsy. Although the mean post-fixation specimen length in the biopsy-positive group (18.35 ± 6.9 mm) was longer than that in the biopsy-negative group (15.62 ± 8.4 mm), the difference was not statistically significant (P = 0.21). There was no statistically significant difference between the groups in terms of sex, serum hemoglobin, platelet count, and erythrocyte sedimentation rate. There were statistically significant differences between the biopsy-negative and biopsy-positive groups with respect to patients’ age and C-reactive protein level (P < 001 and P = 0.012, respectively).

Conclusion: The majority of TABs were negative. Reducing the number of redundant biopsies is necessary to decrease workload and use of medical services. We suggest that the diagnosis of GCA should be dependent on clinical suspicion.


Anterior Ischemic Optic Neuropathy, Giant Cell Arteritis, Temporal Arteritis, Temporal Artery Biopsy

1. Chew SS, Kerr NM, Danesh-Meyer H V. Giant cell arteritis. J Clin Neurosci 2009;16:1263–1268.

2. Hayreh SS. Ischemic optic neuropathy. Prog Retin Eye Res 2009;28:34–62.

3. Hayreh SS. Ischemic optic neuropathies - where are we now? Graefes Arch Clin Exp Ophthalmol 2013;251:1873–1884.

4. Au CP, Sharma NS, McCluskey P, Ghabrial R. Increase in the length of superficial temporal artery biopsy over 14 years. Clin Exp Ophthalmol 2016;44:550–554.

5. Hunder GG, Bloch DA, Michel BA, Stevens MB, Arend WP, Calabrese LH, et al. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum 1990;33:1122–1128.

6. Tehrani R, Ostrowski RA, Hariman R, Jay WM. Giant cell arteritis. Semin Ophthalmol 2008;23:99–110.

7. Salehi-Abari I. 2016 ACR revised criteria for early diagnosis of giant cell (temporal) arteritis. Autoimmune Dis Ther Approaches Open Access 2016;3:1–4.

8. Cristaudo AT, Mizumoto R, Hendahewa R. The impact of temporal artery biopsy on surgical practice. Ann Med Surg 2016;11:47–51.

9. Manjuka R, David TAH. Temporal artery biopsies: a fresh perspective. ANZ J Surg 2010;80:479–80.

10. Miller A, Green M, Robinson D. Simple rule for calculating normal erythrocyte sedimentation rate. Br Med J (Clin Res Ed) 1983;286:266.

11. Cahais J, Houdart R, Lupinacci RM, Valverde A. Operative technique: superficial temporal artery biopsy. J Visc Surg 2017;154:203–207.

12. Oh LJ, Wong E, Gill AJ, McCluskey P, Smith JEH. Value of temporal artery biopsy length in diagnosing giant cell arteritis. ANZ J Surg 2018;88:191–195.

13. Ashton-Key MR, Gallagher PJ. False-negative temporal artery biopsy. Am J Surg Pathol 1992;16:634–635.

14. Murchison AP, Gilbert ME, Bilyk JR, Eagle Jr. RC, Pueyo V, Sergott RC, et al. Validity of the American College of Rheumatology criteria for the diagnosis of giant cell arteritis. Am J Ophthalmol 2012;154:722–729.

15. Ing EB, Lahaie Luna G, Toren A, Ing R, Chen JJ, Arora N, et al. Multivariable prediction model for suspected giant cell arteritis: development and validation. Clin Ophthalmol 2017;11:2031–2042.

16. Sait MR, Lepore M, Kwasnicki R, Allington J, Balasubramanian R, Somasundaram SK, et al. The 2016 revised ACR criteria for diagnosis of giant cell arteritis – our case series: can this avoid unnecessary temporal artery biopsies? Int J Surg Open 2017;9:19–23.

17. Buttgereit F, Dejaco C, Matteson EL, Dasgupta B. Polymyalgia rheumatica and giant cell arteritis a systematic review. JAMA 2016;315:2442–2458.

18. Pfadenhauer K, Esser M, Berger K. Vertebrobasilar ischemia and structural abnormalities of the vertebral arteries in active temporal arteritis and polymyalgia rheumatica - an ultrasonographic case-control study. J Rheumatol 2005;32:2356–2360.

19. Schmidt WA, Seifert A, Gromnica-ihle E, Krause A, Natusch A. Ultrasound of proximal upper extremity arteries to increase the diagnostic yield in large-vessel giant cell arteritis. Rheumatology 2008;47:96–101.

20. Czihal M, Zanker S, Rademacher A, Tatò F, Kuhlencordt PJ, Schulze-Koops H, et al. Sonographic and clinical pattern of extracranial and cranial giant cell arteritis. Scand J Rheumatol 2012;41:231–236.

21. Bley TA, Wieben O, Uhl M, Thiel J, Schmidt D, Langer M. High-resolution MRI in giant cell arteritis: imaging of the wall of the superficial temporal artery. Am J Roentgenol 2005;184:283–287.

22. Docken WP. Diagnosis of giant cell arteritis. In: UpToDate. UpToDate Inc.; 2019.

23. Allison MC, Gallagher PJ. Temporal artery biopsy and corticosteroid treatment. Ann Rheum Dis 1984;43:416–417.

24. Kent 3rd RB, Thomas L. Temporal artery biopsy. Am Surg 1990;56:16–21.

25. Achkar AA, Lie JT, Hunder GG, O’Fallon WM, Gabriel SE. How does previous corticosteroid treatment affect the biopsy findings in giant cell (temporal) arteritis? Ann Intern Med 1994;120:987–992.

26. Sudlow C. Diagnosing and managing polymyalgia rheumatica and temporal arteritis. Sensitivity of temporal artery biopsy varies with biopsy length and sectioning strategy. BMJ 1997;315:549.

27. Taylor-Gjevre R, Vo M, Shukla D, Resch L. Temporal artery biopsy for giant cell arteritis. J Rheumatol 2005;32:1279–1282.

28. Arashvand K. The value of temporal artery biopsy specimen length in the diagnosis of giant cell arteritis. J Rheumatol 2006;33:2363–2364; author reply 2364.

29. Mahr A, Saba M, Kambouchner M, Polivka M, Baudrimont M, Brocheriou I, et al. Temporal artery biopsy for diagnosing giant cell arteritis: the longer, the better? Ann Rheum Dis 2006;65:826–828.

30. Sharma NS, Ooi JL, McGarity BH, Vollmer-Conna U, McCluskey P. The length of superficial temporal artery biopsies. ANZ J Surg 2007;77:437–439.

31. Breuer GS, Nesher R, Nesher G. Effect of biopsy length on the rate of positive temporal artery biopsies. Clin Exp Rheumatol 2009;27:S10–S13.

32. Ypsilantis E, Courtney ED, Chopra N, Karthikesalingam A, Eltayab M, Katsoulas N, et al. Importance of specimen length during temporal artery biopsy. Br J Surg 2011;98:1556–1560.

33. Kaptanis S, Perera JK, Halkias C, Caton N, Alarcon L, Vig S. Temporal artery biopsy size does not matter. Vascular 2014;22:406–410.

34. Grossman C, Barshack I, Bornstein G. Association between specimen length and diagnostic yield of temporal artery biopsy. Scand J Rheumatol 2016;9742:2– 6.

35. Gajree S, Borooah S, Dhillon N, Goudie C, Smith C, Aspinall P, et al. Temporal artery biopsies in south-east Scotland: a five year review. J R Coll Physicians Edinb 2017;47:124–128.

36. Papadakis M, Kaptanis S, Kokkori-Steinbrecher A, Floros N, Schuster F, Hubner G. Temporal artery biopsy in the diagnosis of giant cell arteritis: bigger is not always better. Am J Surg 2018;215:647–650.