Abstract
Currently, there is no mechanism for service validation of diagnostic ultrasonography (US) for giant cell arteritis (GCA). Temporal artery biopsy (TAB) and classification criteria are poor benchmarks. We validated our service against physician-verified diagnosis at 100 weeks (100wD). Twenty-five patients underwent US within 7 days, and TAB within 28 days, of commencing prednisolone. US, TAB and baseline diagnosis (bD) were all compared with 100wD using Cohen’s kappa. Fourteen US and 8 TABs were positive. Twenty at baseline and 14 at 100 weeks had diagnosis of GCA. The kappa (95% CI) were 0.4 (0.1, 0.7) for US vs. TAB; 0.5 (0.2, 0.8) for US vs. bD and 0.2 (0.0, 0.4) for TAB vs. bD. Versus 100wD, the kappa (95% CI) were 0.8 (0.6, 1.0) for US; 0.4 (0.1, 0.7) for TAB and 0.6 (0.3, 0.9) for bD. Seven cases were US+/TAB−. Four had alternate confirmation: 18FDG-PET (n = 1), CT Aorta (n = 1) and US at relapse (n = 2). At 100 weeks, 4 cases (all US−/TAB−) with bD of GCA had alternative diagnoses including cancer (n = 2). This is the first study validating US service provision for GCA. Twenty-five US with a robust kappa on comparison with long-term diagnosis validates our service. A diagnosis of GCA should be made with extreme caution for US−/TAB− cases.
Key Points • This is the first study offering a way to validate a new diagnostic US service by validation against TAB and long-term physician-verified diagnosis. • US has substantial to near-perfect agreement with long-term physician-verified diagnosis and is more reliable than TAB in our hands. • Alternative diagnoses should be sought in patients with dual negativity for US and TAB. |
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References
Mukhtyar C, Guillevin L, Cid MC, Dasgupta B, de Groot K, Gross W, Hauser T, Hellmich B, Jayne D, Kallenberg CGM, Merkel PA, Raspe H, Salvarani C, Scott DGI, Stegeman C, Watts R, Westman K, Witter J, Yazici H, Luqmani R, for the European Vasculitis Study Group (2009) EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis 68:318–323
Hellmich B, Agueda A, Monti S, Buttgereit F, de Boysson H, Brouwer E, Cassie R, Cid MC, Dasgupta B, Dejaco C, Hatemi G, Hollinger N, Mahr A, Mollan SP, Mukhtyar C, Ponte C, Salvarani C, Sivakumar R, Tian X, Tomasson G, Turesson C, Schmidt W, Villiger PM, Watts R, Young C, Luqmani RA (2019) 2018 update of the EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis. https://doi.org/10.1136/annrheumdis-2019-215672
Hernandez-Rodriguez J, Murgia G, Villar I, Campo E, Mackie SL, Chakrabarty A et al (2016) Description and validation of histological patterns and proposal of a dynamic model of inflammatory infiltration in giant-cell arteritis. Medicine (Baltimore) 95:e2368
Le K, Bools LM, Lynn AB, Clancy TV, Hooks WB 3rd, Hope WW (2015) The effect of temporal artery biopsy on the treatment of temporal arteritis. Am J Surg 209:338–341
Aranda-Valera IC, Garcia Carazo S, Monjo Henry I, De Miguel Mendieta E (2017) Diagnostic validity of Doppler ultrasound in giant cell arteritis. Clin Exp Rheumatol 35:S123–S127
Luqmani R, Lee E, Singh S, Gillett M, Schmidt WA, Bradburn M, Dasgupta B, Diamantopoulos AP, Forrester-Barker W, Hamilton W, Masters S, McDonald B, McNally E, Pease C, Piper J, Salmon J, Wailoo A, Wolfe K, Hutchings A (2016) The role of ultrasound compared to biopsy of temporal arteries in the diagnosis and treatment of giant cell arteritis (TABUL): a diagnostic accuracy and cost-effectiveness study. Health Technol Assess 20:1–238
Rao JK, Allen NB, Pincus T (1998) Limitations of the 1990 American College of Rheumatology classification criteria in the diagnosis of vasculitis. Ann Intern Med 129:345–352
Barrier J, Potel G, Renaut-Hovasse H, Hanh TH, Peltier P, Chamary V, Grolleau JY (1982) The use of Doppler flow studies in the diagnosis of giant cell arteritis. Selection of temporal artery biopsy site is facilitated. Jama 248:2158–2159
Schmidt WA, Kraft HE, Volker L, Vorpahl K, Gromnica-Ihle EJ (1995) Colour Doppler sonography to diagnose temporal arteritis. Lancet 345:866
Kraft HE, Moller DE, Volker L, Schmidt WA (1996) Color Doppler ultrasound of the temporal arteries--a new method for diagnosing temporal arteritis. Klin Monatsbl Augenheilkd 208:93–95
Dejaco C, Ramiro S, Duftner C, Besson FL, Bley TA, Blockmans D, Brouwer E, Cimmino MA, Clark E, Dasgupta B, Diamantopoulos AP, Direskeneli H, Iagnocco A, Klink T, Neill L, Ponte C, Salvarani C, Slart RHJA, Whitlock M, Schmidt WA (2018) EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice. Ann Rheum Dis 77:636–643
Rinagel M, Chatelus E, Jousse-Joulin S, Sibilia J, Gottenberg JE, Chasset F, Arnaud L (2019) Diagnostic performance of temporal artery ultrasound for the diagnosis of giant cell arteritis: a systematic review and meta-analysis of the literature. Autoimmun Rev 18:56–61
De Miguel E, Castillo C, Rodriguez A, De Agustin JJ (2009) Learning and reliability of colour Doppler ultrasound in giant cell arteritis. Clin Exp Rheumatol 27:S53–S58
Chrysidis S, Duftner C, Dejaco C, Schäfer VS, Ramiro S, Carrara G, Scirè CA, Hocevar A, Diamantopoulos AP, Iagnocco A, Mukhtyar C, Ponte C, Naredo E, de Miguel E, Bruyn GA, Warrington KJ, Terslev L, Milchert M, D’Agostino MA, Koster MJ, Rastalsky N, Hanova P, Macchioni P, Kermani TA, Lorenzen T, Døhn UM, Fredberg U, Hartung W, Dasgupta B, Schmidt WA (2018) Definitions and reliability assessment of elementary ultrasound lesions in giant cell arteritis: a study from the OMERACT Large Vessel Vasculitis Ultrasound Working Group. RMD Open 4:e000598
Mukhtyar C, Cate H, Graham C, Merry P, Mills K, Misra A, Jones C (2019) Development of an evidence-based regimen of prednisolone to treat giant cell arteritis – the Norwich regimen. Rheumatol Adv Pract 3:rkz001
Jakobsson K, Jacobsson L, Mohammad AJ, Nilsson J, Warrington K, Matteson EL et al (2016) The effect of clinical features and glucocorticoids on biopsy findings in giant cell arteritis. BMC Musculoskelet Disord 17:363
Hedges TR 3rd, Gieger GL, Albert DM (1983) The clinical value of negative temporal artery biopsy specimens. Arch Ophthalmol 101:1251–1254
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Mukhtyar, C., Myers, H., Scott, D.G.I. et al. Validating a diagnostic GCA ultrasonography service against temporal artery biopsy and long-term clinical outcomes. Clin Rheumatol 39, 1325–1329 (2020). https://doi.org/10.1007/s10067-019-04772-2
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DOI: https://doi.org/10.1007/s10067-019-04772-2