An Audit of Utility and Cost of Temporal Artery Biopsy in a Regional Centre

Background: Giant Cell Arteritis (GCA) is a common chronic idiopathic vasculitis of medium to large vessels that can cause permanent visual loss and stroke. Temporal Artery Biopsy (TAB) is the gold standard diagnostic test with specificity up to 100%, but a poor sensitivity, which can range between 39-77%. TAB evaluates only a small section of a vessel in a systemic disease. Recent literature suggests that diagnostic Ultrasound (US) provides a cost-effective and safer alternative in the diagnosis of GCA (sensitivity 54-92%, specificity 83-96%). This study aims to review the impact of TAB in our regional center and emergency theatre utilization. Method: A retrospective audit of all patients who underwent TAB at Albany Hospital between January 2009 and June 2019. Medical records were reviewed for histopathology and demographic data. All TAB were performed in theatre under local anaesthetic and 45% were performed by the trainee registrar. Results: 62 TAB were performed on 61 patients. 70% of patients were female with a mean age of 69.8 years. One patient's histopathology results were unattainable. 11 patients (18%) had positive histopathology that confirmed GCA. One of these patients had findings of treated arteritis. 49 out of 60 patients (81.7%) had negative histopathology findings. Conclusion: The positive biopsy rate is slightly lower than most contemporary cohorts. There may be a role for training in vascular US in our regional center, which will not only save in theatre costs but also expedite patient diagnosis and treatment of GCA.