Temporal Artery Biopsy (for temporal arteritis)

Indications

Temporal artery biopsy is a key element in the diagnosis of anterior ischemic optic neuropathy (AION).

Untreated arteritic anterior ischemic optic neuropathy may lead to bilateral, irreversible blindness in a short period of time.

It is permissible to begin treating patients with suspected (AION) while awaiting the results of the temporal artery biopsy. We regard the temporal artery biopsy as a medical emergency, and efforts are made to process tissue on the same day of receipt (if the tissue arrives in the laboratory before 9:30 AM, a final diagnosis based on permanent sections is usually possible by later the same afternoon).

Ophthalmologist may wish to consult an extensive on-line resource on AION and temporal artery biopsy prepared by Professor Sohan S. Hayreh.

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Preparation by Ophthalmologist

In general, the ophthalmologist should strive to obtain a biopsy sample that is at least 1 cm long.

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Preparation by Ophthalmic Histotechnologist/Cytotechnologist

Temporal arteritis may skip normal areas of the artery, but circumferentially and longitudinally.

One strategy employed in this laboratory to detect skip lesions is to obtain multiple cross-sections from the artery (like slicing a loaf of bread). Each of the cross sections is submitted, and step sections (levels) are cut through the block. Usually, the artery is exhausted within 6 levels.

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Issues for the Pathologist

 

To maximize the opportunity to detect skip lesions in a temporal artery biopsy, the pathologist should plan to sample as much of the received tissue as possible. In this laboratory, the artery is sectioned in a bread-loaf fashion to generate multiple cross-sections of the biopsied artery. The cross sections are embedded in one or two blocks (depending upon the length of the artery obtained) and multiple levels are cut through the block.

Positive temporal artery biopsy in a patient with AION. Note that the lumen of this artery is nearly obliterated: the tissues supplied by this inflammed vessel are ischemic.

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More Questions?

If you have more questions about temporal artery biopsy specimens, please contact one of us:

Ophthalmic Pathologists

Robert Folberg, MD, FCAP, Director

Deepak P. Edward, MD

Consultation Coordinator

Marnie Pomeroy

 

 

 

 


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