Temporal Artery Biopsies: Understanding the Low Positivity Rate

Abstract

Objective We compared the yield of temporal artery biopsies with the clinical diagnoses made by referring physicians and determined the factors associated with a positive biopsy. Methods This is a monocentric, retrospective analytical study of patients treated between January 2021 and December 2024 who underwent temporal artery biopsy for suspected giant cell arteritis. The primary endpoint was the biopsy positivity rate. We also studied patient-related factors, symptoms, and clinical variables, including surgical and pathological factors, to identify those associated with a positive biopsy result. Results The study included 72 patients (40 females, 32 males). General health deterioration (OR = 3.71, p = 0.05) was significantly associated with a positive biopsy in the univariate analysis. The average length of the biopsy specimen after fixation was 13.4 mm. The positivity rate of temporal artery biopsies was 16.6% (n=12), while in 55.5% of cases (n=40), referring physicians ultimately diagnosed typical isolated Horton's disease (n=29, 40.2%) or isolated Horton's disease associated (n=10, 13.8%) with pseudo-polyarthritis rheumatica. Conclusion The anatomic-clinical discordance highlighted in our study supports findings from the literature. This can be explained by factors related to the pathology itself but also by a proactive diagnostic approach and variability in performing the surgical procedure. We have proposed avenues to refine the indications for this procedure and improve the performance of our technique. Temporal artery biopsy should be reserved for well-supported suspicions of Horton's disease. Sampling upstream from the bifurcation of the superficial temporal artery appears to offer the best reproducibility.

Keywords: general plastic surgery; good clinical practices; large-vessel vasculitis and gca; temporal arteritis; temporal artery biopsy.

Figure 1. Anatomopathological section of a positive temporal artery biopsy after staining with hematoxylin and eosin, magnified 10x.

The arrow indicates a pan-wall inflammatory infiltrate marked by the presence of small lymphocytes (dark purple nuclei) extending from the intima to the adventitia. The circle indicates a multinucleated giant cell. This image has never been used for publication and has been authorized for publication by the Department of Pathology at Centre Hospitalier Universitaire of Reims.

Figure 2. Illustration of the areas of caution during a superficial temporal artery biopsy.

The sample is taken above the tragus, in line with the vertical branch of the superficial temporal artery. Caution is exercised with the auriculotemporal nerve, which runs dorsally to the superficial temporal artery, and more anteriorly with the frontal branch of the facial nerve. This image was generated using artificial intelligence using the Canva software, which utilizes advanced algorithms to create visuals based on user inputs and design preferences. The annotations have been added by the author using the same software.