Cohen Devon A, Chen John J, Neth Bryan J, Sabbagh Nouran, Hodge David, Warrington Kenneth J, Fillmore Jonathan, Maleszewski Joseph J, Salomao Diva R, Bhatti M Tariq
Department of Neurology, Mayo Clinic College of Medicine & Science, Rochester, Minnesota.
Department of Ophthalmology, Mayo Clinic College of Medicine & Science, Rochester, Minnesota.
JAMA Ophthalmol. 2021 Apr 1;139(4):406-413. doi: 10.1001/jamaophthalmol.2020.6896.
Frozen section temporal artery biopsy (TAB) may prevent a contralateral biopsy from being performed.
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.
Sensitivity and specificity of frozen section TAB for detecting GCA, and discordance rates of bilateral permanent section TAB.
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).
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.
颞动脉活检（TAB）冰冻切片可避免对侧活检的进行。
评估TAB冰冻切片与永久切片病理结果对巨细胞动脉炎（GCA）的敏感性和特异性，并确定双侧TAB的不一致率。
设计、设置和参与者：在这项回顾性队列研究中，回顾了2010年1月1日至2018年12月1日在一家具备冰冻和永久组织切片能力的三级医疗中心接受TAB的795名40岁及以上患者的病历。2019年1月至2020年12月进行数据分析。
检测GCA的TAB冰冻切片的敏感性和特异性，以及双侧永久切片TAB的不一致率。
795名纳入参与者中，329名（41.4%）为男性，平均（标准差）年龄为72（10）岁。在795例患者的1162次TAB中，119例患者（15.0%）和138次TAB在永久切片上有阳性发现。在这119例患者中，103例（86.6%）在冰冻切片上也有阳性结果，有4例假阳性（0.6%）和20例假阴性（16.8%）。冰冻切片的特异性为99.4%（95%CI，98.5 - 99.8），敏感性为83.2%（95%CI，75.2 - 89.4），阳性预测值为96.1%（95%CI，90.4 - 98.9），阴性预测值为96.6%（95%CI，94.9 - 97.8），阳性似然比为140.6（95%CI，72.7 - 374.8），阴性似然比为0.17（95%CI，0.11 - 0.25）。60例患者（7.5%）同时进行了双侧TAB，永久切片的不一致率为5%。相比之下，307例患者（38.6%）进行了双侧冰冻切片引导的序贯TAB，基于永久切片的不一致率为5.5%。在多变量模型中，年龄较大（优势比[OR]，1.04；95%CI，1.01 - 1.07；P = 0.008）、视力丧失（OR，2.72；95%CI，1.25 - 5.75；P = 0.0
