Temporal Artery Biopsy in Miranda
Dr Adrian Hunt can usually add a temporal artery biopsy to his weekly Wednesday operating list when a patient with suspected giant cell arteritis (GCA) needs one. If you have a patient you are concerned about, call the rooms on (02) 8544 0719.
Suspected GCA — call the rooms
Do not delay high-dose corticosteroids pending biopsy. Biopsy is ideally performed within ten days of starting steroids. After hours, patients with acute vision loss, diplopia or amaurosis fugax should go to Sydney Eye Hospital Emergency.
A Few Practical Pointers
When to suspect GCA. Patient over fifty with any convincing combination of: new temporal or occipital headache, jaw claudication, scalp tenderness, transient or sudden visual loss, new diplopia, loss of weight, loss of appetite, or other constitutional symptoms similar to polymyalgia rheumatica. A tender or pulseless temporal artery is a useful examination sign. GCA can also present with ocular symptoms alone.
ESR and CRP. Draw both before steroids where possible. ESR above 50 mm/hr is the classic threshold; above 100 is strongly suggestive. CRP is more sensitive than ESR alone, and the two together approach 99% sensitivity in biopsy-proven disease. ESR is normal in up to a third of cases — so normal markers do not exclude GCA in a patient with a convincing clinical picture.
Pretest probability matters. The same result means different things in different patients. A borderline ESR in a seventy-five-year-old with jaw claudication and new headache warrants urgent workup; the same number in a younger patient with isolated headache does not. Weigh the markers and the biopsy result against the strength of the clinical picture.
Timing of biopsy. Steroids should never be delayed pending biopsy, but once they are running the clock starts. Histological signs melt away on treatment — ideally biopsy is within ten days of starting steroids. Beyond two to four weeks, biopsies often return normal even in active disease.
A negative biopsy does not exclude GCA. No single test rules the diagnosis in or out. Treatment is continued on clinical grounds where suspicion remains high.
The Biopsy
Performed under local anaesthesia on the Wednesday operating list. A segment of superficial temporal artery is excised through a small incision behind the hairline and sent for histology. The patient goes home the same day.
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