Edsel B Ing1, Dan Ni Wang2, Abirami Kirubarajan3, Etienne Benard-Seguin4, Jingyi Ma5, James P Farmer6,7, Michel J Belliveau6, Galina Sholohov8, Nurhan Torun9. 1. University of Toronto Ophthalmology, Michael Garron Hospital, University of Toronto, Toronto, Canada. 2. Cumming School of Medicine, University of Calgary, Calgary, Canada. 3. School of Medicine, University of Toronto, Toronto, Canada. 4. School of Medicine, Queens University, Kingston, Canada. 5. Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada. 6. Department of Ophthalmology, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Canada. 7. Anatomic Pathology, University of Ottawa and Queens University, Ottawa, Canada. 8. Barzilai Medical Center, ISL, Ashkelon, Israel. 9. Harvard University Ophthalmology, Beth Israel Deaconness, Boston, Massachusetts, USA.
Abstract
PURPOSE: To determine the positive yield (utility rate) of temporal artery biopsy (TAB) in patients with suspected giant cell arteritis (GCA). STUDY DESIGN: Systematic review (CRD42017078508) and meta-regression. MATERIALS AND METHODS: All articles concerning TAB for suspected GCA with English language abstracts from 1998 to 2017 were retrieved. Articles were excluded if they exclusively reported positive TAB, or only cases of known GCA. Where available, the pre-specified predictors of age, sex, vision symptoms, jaw claudication, duration of steroid treatment prior to TAB, specimen length, bilateral TAB, and use of ultrasound/MRI (imaging) were recorded for meta-regression. RESULTS: One hundred and thirteen articles met eligibility criteria. The I 2 was 92%, and with such high heterogeneity, meta-analysis is unsuitable. The median yield of TAB was 0.25 (95% confidence interval 0.21 to 0.27), with interquartile range 0.17 to 0.34. On univariate meta-regression age (coefficient 0.012, p = 0.025) was the only statistically significant patient factor associated with TAB yield. CONCLUSIONS: Systematic review revealed high heterogeneity in the yield of TAB. The median utility rate of 25% and its interquartile range provides a benchmark for decisions regarding the under/overutilization of TAB and aids in the evaluation of non-invasive alternatives for the investigation of GCA.
PURPOSE: To determine the positive yield (utility rate) of temporal artery biopsy (TAB) in patients with suspected giant cell arteritis (GCA). STUDY DESIGN: Systematic review (CRD42017078508) and meta-regression. MATERIALS AND METHODS: All articles concerning TAB for suspected GCA with English language abstracts from 1998 to 2017 were retrieved. Articles were excluded if they exclusively reported positive TAB, or only cases of known GCA. Where available, the pre-specified predictors of age, sex, vision symptoms, jaw claudication, duration of steroid treatment prior to TAB, specimen length, bilateral TAB, and use of ultrasound/MRI (imaging) were recorded for meta-regression. RESULTS: One hundred and thirteen articles met eligibility criteria. The I 2 was 92%, and with such high heterogeneity, meta-analysis is unsuitable. The median yield of TAB was 0.25 (95% confidence interval 0.21 to 0.27), with interquartile range 0.17 to 0.34. On univariate meta-regression age (coefficient 0.012, p = 0.025) was the only statistically significant patient factor associated with TAB yield. CONCLUSIONS: Systematic review revealed high heterogeneity in the yield of TAB. The median utility rate of 25% and its interquartile range provides a benchmark for decisions regarding the under/overutilization of TAB and aids in the evaluation of non-invasive alternatives for the investigation of GCA.
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Authors: Edsel B Ing; Neil R Miller; Angeline Nguyen; Wanhua Su; Lulu L C D Bursztyn; Meredith Poole; Vinay Kansal; Andrew Toren; Dana Albreki; Jack G Mouhanna; Alla Muladzanov; Mikaël Bernier; Mark Gans; Dongho Lee; Colten Wendel; Claire Sheldon; Marc Shields; Lorne Bellan; Matthew Lee-Wing; Yasaman Mohadjer; Navdeep Nijhawan; Felix Tyndel; Arun N E Sundaram; Martin W Ten Hove; John J Chen; Amadeo R Rodriguez; Angela Hu; Nader Khalidi; Royce Ing; Samuel W K Wong; Nurhan Torun Journal: Clin Ophthalmol Date: 2019-02-21