Frozen Section Temporal Artery Biopsy Reliably Indicates Giant Cell Arteritis

Positive findings from frozen section temporal artery biopsy (TAB) can be reliably used to indicate a diagnosis of giant cell arteritis (GCA) without necessitating a contralateral biopsy, according to study results published in JAMA Ophthalmology. 

Researchers conducted a retrospective medical review of patients who underwent TAB to systematically assess the sensitivity and specificity of frozen vs permanent section TAB pathology results in evaluating suspected GCA. 

The cohort included 795 participants (41.4% men; mean age, 72 years ± 10 years) with 1162 TABs (428 unilateral biopsies and 367 bilateral biopsies). In total, 119 patients and 138 TABs had positive findings; among these patients, 86.6% had positive results on the frozen section (0.6% false positive and 16.8% false negatives). The frozen section specificity was 99.4% (95% CI, 98.5-99.8) and sensitivity was 83.2% (95% CI, 75.2-89.5). Positive and negative predictive values were 96.1% and 96.6%, respectively. 

The investigators found that frozen section TAB was associated with 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). These results indicated, per researchers, that patients with a positive frozen section have a greater likelihood of having a positive permanent section. 

Results of a univariate regression analysis indicated that all clinical symptoms except headaches were associated with higher statistical odds of a positive permanent section TAB. In particular, the presence of anorexia and jaw claudication (odds ratios [ORs] 7.11 and 5.28, respectively), had the highest association with positive section TAB. Initiation of glucocorticoids prior to tab — but not chronic glucocorticoid use — was also associated with positive TAB (OR, 2.01). 

Results of a multivariate analysis, adjusted for erythrocyte sedimentation rate, C-reactive protein, platelets, the presence of jaw claudication, or scalp tenderness indicated greater odds 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). 

Sixty patients underwent simultaneous TABs; a 5% discordance rate was noted between the 2 sides. Among those who underwent frozen section-guided sequential TABs (38.6%), there was a 5.5% discordance rate. Twenty-seven bilateral TABs were positive for giant cell arteritis on the permanent section; of these 4 were simultaneous and 23 were sequential. Overall, there were 49 patients with bilateral TABs who had abnormal permanent section results on one or both sides — 22 of these patients demonstrated no evidence of active inflammation. 

Study limitations include the single-center retrospective nature of the analysis, the use of original pathology reports rather than a review of all TABs, and controversies surrounding the clinical interpretation of healed arteritis. 

“Our study has shown that frozen section TAB has a 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 demographic characteristics between positive and negative frozen and permanent TAB results are needed to confirm our findings.” 

Disclosure: One study author declared an affiliation with the biotech or pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Cohen DA, Chen KK, Neth BJ, et al. Discordance rate among bilateral simultaneous and sequential temporal artery biopsies in giant cell arteritis: Role of frozen sectioning based on the Mayo Clinic experience. Published online February 18, 2021. JAMA Ophthalmol. doi:10.1001/jamaophthalmol.2020.6896