Positive frozen section temporal artery biopsy (TAB) results can be reliably used to indicate a diagnosis of giant cell arteritis (GCA) without the need for a contralateral biopsy, as shown by study results published in JAMA Ophthalmology.
Researchers conducted a retrospective medical review of patients who had undergone TAB to systematically assess the sensitivity and specificity of the frozen or permanent cut TAB pathology results in assessing the suspicion of GCA.
The cohort consisted of 795 participants (41.4% men; mean age 72 years ± 10 years) with 1162 TABs (428 unilateral biopsies and 367 bilateral biopsies). A total of 119 patients and 138 TABs had positive results; Of these patients, 86.6% had positive frozen section results (0.6% false positive and 16.8% false negative). The frozen section specificity was 99.4% (95% CI, 98.5-99.8) and the sensitivity was 83.2% (95% CI, 75.2-89.5). Positive and negative predictive values were 96.1% and 96.6%, respectively.
The researchers found that frozen section TAB had a positive likelihood ratio of 140.6 (95% CI, 72.7-374.8) and a negative likelihood ratio of 0.17 (95% CI, 0.11-0.25 ) was associated. These results showed, according to researchers, that patients with a positive frozen cut are more likely to have a positive permanent cut.
The results of a univariate regression analysis showed that all clinical symptoms with the exception of headache were associated with a higher statistical probability of a positive TAB on the permanent average. In particular, the presence of anorexia and jaw claudication (odds ratios) [ORs] 7.11 and 5.28) had the highest association with the positive section TAB. The introduction of glucocorticoids before the tab – but not the chronic use of glucocorticoids – was also associated with a positive TAB (OR, 2.01).
The results of a multivariate analysis, adjusted for the sedimentation rate of the erythrocytes, the C-reactive protein, the blood platelets, the presence of jaw claudication or the sensitivity of the scalp, showed a greater likelihood of a positive permanent TAB with age, vision loss, diplopia, headache, weight loss and anorexia (ORs, 1.04, 2.72, 3.33, 2.32, 2.37 and 5.65, respectively).
60 patients received TABs at the same time; A discordance rate of 5% was found between the two sides. Among those who performed sequential frozen section TABs (38.6%), there was a discordance rate of 5.5%. 27 bilateral TABs were positive for giant cell arteritis in the permanent section; of these 4 were concurrent and 23 were sequential. There were a total of 49 patients with bilateral TABs who had abnormal permanent section results on one or both sides – 22 of these patients showed no evidence of active inflammation.
The limitations of the study include the retrospective nature of the analysis at a center, the use of original pathology reports in lieu of a review of all TABs, and controversies related to the clinical interpretation of the healed arteritis.
“Our study showed that frozen section TAB has very good sensitivity and excellent specificity for GCA and therefore supports the role of frozen section in performing TAB,” the researchers conclude. “However, more studies with a comparative analysis of laboratory results, clinical symptoms and patient demographics between positive and negative frozen and permanent TAB results are needed to confirm our results.”
Disclosure: A study author declared an affiliation to the biotech or pharmaceutical industry. For a full list of the authors’ information, see the original reference.
Cohen DA, Chen KK, Neth BJ et al. Discordance rate between bilateral simultaneous and sequential biopsies of the temporal arteries in giant cell arteritis: role of frozen sections based on the experience of the Mayo Clinic. Published online February 18, 2021. JAMA Ophthalmol. doi: 10.1001 / jamaophthalmol.2020.6896
This article originally appeared on Ophthalmology Advisor