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Effect of ultrasound use on the pathological outcomes in temporal artery biopsy

Year 2021, , 278 - 282, 29.09.2021
https://doi.org/10.18663/tjcl.936061

Abstract

Aim:This study aimed to determine whether there is a significant difference between the results of a standard biopsy and Doppler ultrasonography-guided biopsy of the temporal artery, which showed low preoperative pulse pressure.
Material and Methods: Data from 21 patients, who received preliminary diagnosis of temporal arteritis at the neurology clinic were retrospectively investigated. Patients were divided into two groups depending on the method with Doppler ultrasonography and without ultrasonography.
Results: Results from a total of 21 patients were evaluated. The first group consisted of 11 patients who underwent standard temporal artery biopsy, while the second group consisted of 10 patients who underwent ultrasonography-guided biopsy. Six patients in the group without the ultrasonography guidance showed insignificant results. Furthermore, the samples were insufficient in four of these six patients. In contrast, four patients from the Doppler ultrasonography-guided group were diagnosed with arteritis, in addition to the fact that an insufficient biopsy sample was not encountered in these patients.
Statistical analysis showed that there was no significant difference between the pathology results of the two groups.
Conclusion: Although we failed to find a significant difference between the groups, we believe that the Doppler ultrasonography-guided biopsy should be used as a supportive tool rather than diagnostic tool per se, as the Doppler ultrasonography-guided group did not provide insufficient biopsy samples in the pathology results as opposed to the standard group.

References

  • 1. Turesson C, Börjesson O, Larsson K, Mohammad AJ, Knight A. Swedish Society of Rheumatology 2018 guidelines for investigation, treatment, and follow-up of giant cell arteritis. Scandinavian Journal of Rheumatology 2019; 48: 1-7.
  • 2. Mohammad AJ, Nilsson J-Å, Jacobsson LT, Merkel PA, Turesson C. Incidence and mortality rates of biopsy-proven giant cell arteritis in southern Sweden. Annals of the Rheumatic Diseases 2015; 74: 993-7.
  • 3. Wojczal J, Kozera G, Luchowski P, Neubauer-Geryk J. Advantages in diagnosis of giant cell arteritis by ultrasound. Advances in Dermatology and Allergology/Postȩpy Dermatologii i Alergologii 2019; 36: 25.
  • 4. Huston KA, Hunder GG, Lie JT, Kennedy RH, Elveback LR. Temporal arteritis: a 25-year epidemiologic, clinical, and pathologic study. Annals of Internal Medicine 1978; 88: 162-7.
  • 5. Nesher G. The diagnosis and classification of giant cell arteritis. Journal of Autoimmunity 2014; 48: 73-5.
  • 6. Font C, Cid MC, Coll-Vinent B, López-Soto A, Grau JM. Clinical features in patients with permanent visual loss due to biopsy-proven giant cell arteritis. British Journal of Rheumatology 1997 ;36: 251-4.
  • 7. Salvarani C, Cantini F, Boiardi L, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. The New England Journal of Medicine 2002; 347: 261-71.
  • 8. Salvarani C, Pipitone N, Versari A, Hunder GG. Clinical features of polymyalgia rheumatica and giant cell arteritis. Nature Reviews Rheumatology 2012; 8: 509-21.
  • 9. Hall S, Lie JT, Kurland LT, Persellin S, O'Brien PC, Hunder GG. The therapeutic impact of temporal artery biopsy. The Lancet 1983; 322: 1217-20.
  • 10. Allsop CJ, Gallagher PJ. Temporal artery biopsy in giant-cell arteritis. A reappraisal. The American Journal of Surgical Pathology 1981; 5: 317-23.
  • 11. Poller D, Van Wyk Q, Jeffrey M. The importance of skip lesions in temporal arteritis. Journal of Clinical Pathology 2000; 53: 137-9.
  • 12. Gonzalez-Gay MA, Garcia-Porrua C, Llorca J, Gonzalez-Louzao C, Rodriguez-Ledo P. Biopsy-negative giant cell arteritis: clinical spectrum and predictive factors for positive temporal artery biopsy. Seminars in arthritis and rheumatism Elsevier 2001; 30: 249-56.
  • 13. Salvarani C, Cimino L, Macchioni P et al. Risk factors for visual loss in an Italian population‐based cohort of patients with giant cell arteritis. Arthritis Care & Research: Official Journal of the American College of Rheumatology 2005; 53: 293-7.
  • 14. Germanò G, Muratore F, Cimino L et al. Is colour duplex sonography-guided temporal artery biopsy useful in the diagnosis of giant cell arteritis? A randomized study. Rheumatology 2014; 54: 400-4.
  • 15. Schmidt WA, Kraft HE, Vorpahl K, Völker L, Gromnica-Ihle EJ. Color duplex ultrasonography in the diagnosis of temporal arteritis. New England Journal of Medicine 1997; 337: 1336-42.
  • 16. Salvarani C, Silingardi M, Ghirarduzzi A et al. Is duplex ultrasonography useful for the diagnosis of giant-cell arteritis? Annals of Internal Medicine 2002; 137: 232-8.
  • 17. Ball EL, Walsh SR, Tang TY, Gohil R, Clarke JM. Role of ultrasonography in the diagnosis of temporal arteritis. British Journal of Surgery 2010; 97: 1765-71.
  • 18. Hauenstein C, Reinhard M, Geiger J et al. Effects of early corticosteroid treatment on magnetic resonance imaging and ultrasonography findings in giant cell arteritis. Rheumatology 2012; 51: 1999-2003.

Temporal arter biyopsilerinde ultrason kullanımının patolojik sonuçlar üzerine etkisi.

Year 2021, , 278 - 282, 29.09.2021
https://doi.org/10.18663/tjcl.936061

Abstract

Amaç: Bu çalışmanın amacı, cerrahi işlem öncesinde nabız basıncı düşük olan temporal arterin, dopler ultrasonografi ile tespit edilen bölgeden alınan biyopsi ile standart biyopsilerin sonuçları arasında anlamlı farklılığın olup olmadığını değerlendirmektir.
Gereç ve Yöntemler: 2013-2019 yılları arasında merkezimizde nöroloji kliniğinde temporal arterit ön tanısı ile değerlendirilen ve biyopsi uygulanması için beyin ve sinir cerrahisi bölümüne konsülte edilen toplam 21 hastanın verileri retrospektif olarak incelendi. Hastaların medikal kayıtlarından toplanan veriler; hastaların demografik özellikleri (yaş, cinsiyet), alınan biyopsinin uzunluğu, görme kaybı varlığı, baş ağrısı varlığı, biyopsi öncesi eritrosit sedimantasyon hızı ile c-reaktif protein düzeyi ve cerrahide dopler ultrasongrafi kullanım durumu kaydedildi.
Hastalar, dopler ultrasonografi kullanılan ve kullanılmayan olarak iki gruba ayrıldı.
Biyopsi öncesi dopler ultrasonografi kullanımında deneyimli, anesteziyoloji uzmanı tarafından inflamasyona bağlı kanlanmanın az olduğu temporal arter trasesi ve dalları cilt üzerinden noktasal işaretleme yapılarak tespit edildi.
Standart biyopsi uygulamasında temporal arterin anatomik lokalizasyonuna göre cilt insizyonu yapılarak, ultrason eşliğindeki biyopside ise belirlenen traseye uygun olacak şekilde yapılan cilt insizyonu ile temporal artere ulaşıldı. Arter dokusundan yaklaşık 2 cm olacak şekilde biyopsi alındı.
Bulgular: Toplam 21 hastanın sonuçları incelendi. Hastalar işlem sırasında dopler ultrasonografi kullanımına göre 2 gruba ayrıldı. İlk grup 11 hastadan oluşan standart temporal arter biyopsi uygulanan grup, ikinci grup ise toplam 10 hastadan oluşan ultrason eşliğinde biyopsi yapılan grup olarak belirlendi. Hastaların ortalama yaşları 69 (39y-90y) olarak bulundu. Ultrason eşliğinde alınan doku örneklerinin ortalama uzunluğu 1,96±0.46 cm, standart cerrahi uygulanan biyopsi örneklerinin ortalama uzunluğunun 1,70±1.07 cm olduğu tespit edildi. Yapılan istatiksel analizde doppler kullanımının alınan örnek uzunluğunda anlamlı bir fark oluşturmadığı tespit edildi. (p=0.215) Biyopsi sırasında ultrason uygulanmayan toplam 11 hastanın altısında patoloji sonucunun anlamlı olmadığı ve bu altı hastadan dördünde patoloji sonucu yetersiz örnek olarak raporladı. Buna karşılık dopler ultrasonografi eşliğinde biyopsi alınan 10 hastanın dördüne arterit tanısı kondu ve yetersiz örnek sonucu ile karşılaşılmadı.
Sonuç: Çalışmamızdaki iki gurup arasında anlamlı fark olmasa da doppler yapılan gruptaki patoloji sonuçlarında yetersiz örnek sonucu ile karşılaşılmamış olması, dopler eşliğinde yapılan biyopsinin tanı koydurucu değil destekleyici uygulama olarak kullanılması kanaatindeyiz.

References

  • 1. Turesson C, Börjesson O, Larsson K, Mohammad AJ, Knight A. Swedish Society of Rheumatology 2018 guidelines for investigation, treatment, and follow-up of giant cell arteritis. Scandinavian Journal of Rheumatology 2019; 48: 1-7.
  • 2. Mohammad AJ, Nilsson J-Å, Jacobsson LT, Merkel PA, Turesson C. Incidence and mortality rates of biopsy-proven giant cell arteritis in southern Sweden. Annals of the Rheumatic Diseases 2015; 74: 993-7.
  • 3. Wojczal J, Kozera G, Luchowski P, Neubauer-Geryk J. Advantages in diagnosis of giant cell arteritis by ultrasound. Advances in Dermatology and Allergology/Postȩpy Dermatologii i Alergologii 2019; 36: 25.
  • 4. Huston KA, Hunder GG, Lie JT, Kennedy RH, Elveback LR. Temporal arteritis: a 25-year epidemiologic, clinical, and pathologic study. Annals of Internal Medicine 1978; 88: 162-7.
  • 5. Nesher G. The diagnosis and classification of giant cell arteritis. Journal of Autoimmunity 2014; 48: 73-5.
  • 6. Font C, Cid MC, Coll-Vinent B, López-Soto A, Grau JM. Clinical features in patients with permanent visual loss due to biopsy-proven giant cell arteritis. British Journal of Rheumatology 1997 ;36: 251-4.
  • 7. Salvarani C, Cantini F, Boiardi L, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. The New England Journal of Medicine 2002; 347: 261-71.
  • 8. Salvarani C, Pipitone N, Versari A, Hunder GG. Clinical features of polymyalgia rheumatica and giant cell arteritis. Nature Reviews Rheumatology 2012; 8: 509-21.
  • 9. Hall S, Lie JT, Kurland LT, Persellin S, O'Brien PC, Hunder GG. The therapeutic impact of temporal artery biopsy. The Lancet 1983; 322: 1217-20.
  • 10. Allsop CJ, Gallagher PJ. Temporal artery biopsy in giant-cell arteritis. A reappraisal. The American Journal of Surgical Pathology 1981; 5: 317-23.
  • 11. Poller D, Van Wyk Q, Jeffrey M. The importance of skip lesions in temporal arteritis. Journal of Clinical Pathology 2000; 53: 137-9.
  • 12. Gonzalez-Gay MA, Garcia-Porrua C, Llorca J, Gonzalez-Louzao C, Rodriguez-Ledo P. Biopsy-negative giant cell arteritis: clinical spectrum and predictive factors for positive temporal artery biopsy. Seminars in arthritis and rheumatism Elsevier 2001; 30: 249-56.
  • 13. Salvarani C, Cimino L, Macchioni P et al. Risk factors for visual loss in an Italian population‐based cohort of patients with giant cell arteritis. Arthritis Care & Research: Official Journal of the American College of Rheumatology 2005; 53: 293-7.
  • 14. Germanò G, Muratore F, Cimino L et al. Is colour duplex sonography-guided temporal artery biopsy useful in the diagnosis of giant cell arteritis? A randomized study. Rheumatology 2014; 54: 400-4.
  • 15. Schmidt WA, Kraft HE, Vorpahl K, Völker L, Gromnica-Ihle EJ. Color duplex ultrasonography in the diagnosis of temporal arteritis. New England Journal of Medicine 1997; 337: 1336-42.
  • 16. Salvarani C, Silingardi M, Ghirarduzzi A et al. Is duplex ultrasonography useful for the diagnosis of giant-cell arteritis? Annals of Internal Medicine 2002; 137: 232-8.
  • 17. Ball EL, Walsh SR, Tang TY, Gohil R, Clarke JM. Role of ultrasonography in the diagnosis of temporal arteritis. British Journal of Surgery 2010; 97: 1765-71.
  • 18. Hauenstein C, Reinhard M, Geiger J et al. Effects of early corticosteroid treatment on magnetic resonance imaging and ultrasonography findings in giant cell arteritis. Rheumatology 2012; 51: 1999-2003.
There are 18 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Orıgınal Artıcle
Authors

Fikret Şahintürk

Erkin Sönmez This is me 0000-0002-5693-3542

Çoşkun Araz This is me 0000-0002-4927-6660

Selim Ayhan 0000-0003-0153-3012

Cem Yılmaz

Publication Date September 29, 2021
Published in Issue Year 2021

Cite

APA Şahintürk, F., Sönmez, E., Araz, Ç., Ayhan, S., et al. (2021). Effect of ultrasound use on the pathological outcomes in temporal artery biopsy. Turkish Journal of Clinics and Laboratory, 12(3), 278-282. https://doi.org/10.18663/tjcl.936061
AMA Şahintürk F, Sönmez E, Araz Ç, Ayhan S, Yılmaz C. Effect of ultrasound use on the pathological outcomes in temporal artery biopsy. TJCL. September 2021;12(3):278-282. doi:10.18663/tjcl.936061
Chicago Şahintürk, Fikret, Erkin Sönmez, Çoşkun Araz, Selim Ayhan, and Cem Yılmaz. “Effect of Ultrasound Use on the Pathological Outcomes in Temporal Artery Biopsy”. Turkish Journal of Clinics and Laboratory 12, no. 3 (September 2021): 278-82. https://doi.org/10.18663/tjcl.936061.
EndNote Şahintürk F, Sönmez E, Araz Ç, Ayhan S, Yılmaz C (September 1, 2021) Effect of ultrasound use on the pathological outcomes in temporal artery biopsy. Turkish Journal of Clinics and Laboratory 12 3 278–282.
IEEE F. Şahintürk, E. Sönmez, Ç. Araz, S. Ayhan, and C. Yılmaz, “Effect of ultrasound use on the pathological outcomes in temporal artery biopsy”, TJCL, vol. 12, no. 3, pp. 278–282, 2021, doi: 10.18663/tjcl.936061.
ISNAD Şahintürk, Fikret et al. “Effect of Ultrasound Use on the Pathological Outcomes in Temporal Artery Biopsy”. Turkish Journal of Clinics and Laboratory 12/3 (September 2021), 278-282. https://doi.org/10.18663/tjcl.936061.
JAMA Şahintürk F, Sönmez E, Araz Ç, Ayhan S, Yılmaz C. Effect of ultrasound use on the pathological outcomes in temporal artery biopsy. TJCL. 2021;12:278–282.
MLA Şahintürk, Fikret et al. “Effect of Ultrasound Use on the Pathological Outcomes in Temporal Artery Biopsy”. Turkish Journal of Clinics and Laboratory, vol. 12, no. 3, 2021, pp. 278-82, doi:10.18663/tjcl.936061.
Vancouver Şahintürk F, Sönmez E, Araz Ç, Ayhan S, Yılmaz C. Effect of ultrasound use on the pathological outcomes in temporal artery biopsy. TJCL. 2021;12(3):278-82.


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