Background Elastic Van Gieson (EVG) stain is used routinely to identify the internal elastic lamina in biopsy specimens from clinically suspected cases of giant cell arteritis (GCA). It is widely recognised, however, that disruption of the internal elastic lamina is not specific for GCA. Evidence suggests that routine use of special stains in temporal artery biopsies does not increase diagnostic sensitivity and current American College of Rheumatology guidelines do not include structural changes to the vessel wall in their recommended diagnostic criteria.
Objective To assess whether use of EVG stain contributes to the diagnosis of GCA, compared with standard H&E stained sections alone.
Methods A retrospective case series of 105 temporal artery biopsies positive for GCA between 1999 and 2009 were retrieved and reviewed histologically. Comparable diagnostic information was extracted from reports for 406 negative biopsies over the same period.
Results Review of H&E stained sections showed diagnostic features of GCA in 97.2% (n=102) of positive cases. Disruption or reduplication of the internal elastic lamina was apparent in 96.1% (n=101) of EVG stained sections, but was also reported as present in nearly two-thirds of negative biopsies.
Conclusions An EVG stain does not contribute to recognition of diagnostic features in a majority of cases and should therefore be reserved for use as a supplementary investigation. Inclusion of pre-biopsy treatment on histology request forms would assist in the interpretation of equivocal biopsies.
- Temporal artery biopsy
- giant cell arteritis
- elastic Van Gieson stain
- ocular pathology
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Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.