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Original Investigation
February 18, 2021

Discordance Rate Among Bilateral Simultaneous and Sequential Temporal Artery Biopsies in Giant Cell Arteritis: Role of Frozen Sectioning Based on the Mayo Clinic Experience

Author Affiliations
  • 1Department of Neurology, Mayo Clinic College of Medicine & Science, Rochester, Minnesota
  • 2Department of Ophthalmology, Mayo Clinic College of Medicine & Science, Rochester, Minnesota
  • 3Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
  • 4Department of Rheumatology, Mayo Clinic College of Medicine & Science, Rochester, Minnesota
  • 5Department of Oral and Maxillofacial Surgery, Mayo Clinic College of Medicine & Science, Rochester, Minnesota
  • 6Department of Laboratory Medicine & Pathology, Mayo Clinic College of Medicine & Science, Rochester, Minnesota
JAMA Ophthalmol. Published online February 18, 2021. doi:10.1001/jamaophthalmol.2020.6896
Key Points

Question  What is the role of frozen sectioning in the determination to perform a contralateral temporal artery biopsy (TAB)?

Findings  In this cohort study including 795 patients, frozen section TAB had a sensitivity of 83.2% and specificity of 99.4% for detecting vascular inflammation consistent with active giant cell arteritis. The discordance rate of bilateral TABs was 5% to 5.5%.

Meaning  A negative frozen section result obtained after a unilateral TAB guides the surgeon to perform a contralateral biopsy in the same sitting, whereas a positive frozen section result can reliably indicate giant cell arteritis without the need for a contralateral biopsy.

Abstract

Importance  Frozen section temporal artery biopsy (TAB) may prevent a contralateral biopsy from being performed.

Objective  To evaluate the sensitivity and specificity of TAB frozen vs permanent section pathology results for giant cell arteritis (GCA) and determine the discordance rate of bilateral TABs.

Design, Setting, and Participants  In this retrospective cohort study, medical records were reviewed from 795 patients 40 years or older who underwent TAB from January 1, 2010, to December 1, 2018, treated at a single tertiary care center with the ability to perform both frozen and permanent histologic sections. Data were analyzed from January 2019 to December 2020.

Main Outcomes and Measures  Sensitivity and specificity of frozen section TAB for detecting GCA, and discordance rates of bilateral permanent section TAB.

Results  Of the 795 included participants, 329 (41.4%) were male, and the mean (SD) age was 72 (10) years. From the 795 patients with 1162 TABs, 119 patients (15.0%) and 138 TABs had positive findings on permanent section. Of these 119 patients, 103 (86.6%) also had positive results on the frozen section, with 4 false-positives (0.6%) and 20 false-negatives (16.8%). Frozen section had a specificity of 99.4% (95% CI, 98.5-99.8), sensitivity of 83.2% (95% CI, 75.2-89.4), positive predictive value of 96.1% (95% CI, 90.4-98.9), negative predictive value of 96.6% (95% CI, 94.9-97.8), 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). Simultaneous bilateral TABs were performed in 60 patients (7.5%) with a 5% discordance rate on permanent section. In comparison, bilateral frozen section–guided sequential TABs were performed in 307 patients (38.6%) with 5.5% discordance based on permanent section. In multivariate models, there was a greater odds of positive findings with age (odds ratio [OR], 1.04; 95% CI, 1.01-1.07; P = .008), vision loss (OR, 2.72; 95% CI, 1.25-5.75; P = .01), diplopia (OR, 3.33; 95% CI, 1.00-10.29; P = .04), headache (OR, 2.32; 95% CI, 1.25-4.53; P = .01), weight loss (OR, 2.37; 95% CI, 1.26-4.43; P = .007), and anorexia (OR, 5.65; 95% CI, 2.70-11.89; P < .001).

Conclusions and Relevance  These results support the hypothesis that negative findings from frozen sections should not be solely relied on to refute the diagnosis of GCA, whereas positive findings from frozen sections can be reliably used to defer a contralateral biopsy pending the permanent section results.

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