Comparison of Current Staging Systems for Sinonasal Inverted Papilloma.
Nakayama Tsuguhisa,Tsunemi Yasuhiro,Kashiwagi Takashi,Kuboki Akihito,Yamakawa Shuchi,Konno Wataru,Mori Aya,Iimura Jiro,Tsukidate Toshiharu,Tanaka Yasuhiro,Haruna Shin-Ichi
American journal of rhinology & allergy
BACKGROUND:A staging system is essential for determining the optimal surgical approach and predicting postoperative outcomes for inverted papilloma (IP). Although staging systems based on the extent to which the location is occupied by an IP have been widely used, an origin site-based classification of IP using unsupervised machine learning algorithms has recently been reported. OBJECTIVE:To determine the most appropriate of five staging systems for sinonasal IP by comparing recurrence rates for each stage according to each of those systems. METHODS:Eighty-seven patients with sinonasal IP were enrolled in the study. Their tumors were retrospectively categorized according to the Krouse, Oikawa, Cannady, and Han staging systems, which are based on the extent of IP, and the Meng system, which is based on the site of origin. The rates of recurrence for each stage of the five systems were compared. RESULTS:Seven of the 87 patients (8.0%) had recurrences during an average 45.5 months (12-138 months) of follow-up. There were significant differences in disease-free survival between the stages specified by Han and Meng (p = 0.027 and p < 0.001, respectively), but not between the stages specified by Krouse, Oikawa, and Cannady (p = 0.236, 0.062, and 0.130, respectively). Cox proportional hazard models revealed that Meng system (adjusted hazard ratio [aHR] 4.32, 95% confidence interval [CI] 1.10-17.04) and presence of dysplasia (aHR 7.42, 95% CI 1.15-47.85) were significantly associated with recurrence. CONCLUSION:The staging systems proposed by Han and Meng were found to be accurate in terms of tumor recurrence. We recommend use of the Han staging system before surgery and the Meng system after intraoperative identification of the origin of the tumor.
Association of Krouse Classification for Sinonasal Inverted Papilloma With Recurrence: A Systematic Review and Meta-analysis.
Lisan Quentin,Moya-Plana Antoine,Bonfils Pierre
JAMA otolaryngology-- head & neck surgery
Importance:The risk factors for the recurrence of sinonasal inverted papilloma are still unclear. Objective:To investigate the potential association between the Krouse classification and the recurrence rates of sinonasal inverted papilloma. Data Sources:The EMBASE and MEDLINE databases were searched for the period January 1, 1964, through September 30, 2016, using the following search strategy: (paranasal sinuses [Medical Subject Headings (MeSH) terms] OR sinonasal [all fields]) AND (inverted papilloma [MeSH terms] OR (inverted [all fields] AND papilloma [all fields]). Study Selection:The inclusion criteria were (1) studies including sinonasal inverted papilloma only and no other forms of papillomas, such as oncocytic papilloma; (2) minimum follow-up of 1 year after the surgery; and (3) clear report of cases (recurrence) and controls according to the Krouse classification system or deducible from the full-text article. Literature search was performed by 2 reviewers. Of the 625 articles retrieved in the literature, 97 full-text articles were reviewed. Observational cohort studies or randomized controlled trials were included, and the following variables were extracted from full-text articles: authors of the study, publication year, follow-up data, and number of cases (recurrence) and controls (no recurrence) in each of the 4 stages of the Krouse classification system. Data Extraction and Synthesis:The Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed. Odds ratios (ORs) and 95% CIs were estimated, and data of included studies were pooled using a random-effects model. Main Outcomes and Measures:The main outcome was recurrence after surgical removal of sinonasal inverted papilloma according to each stage of the Krouse classification system. Results:Thirteen studies comprising 1787 patients were analyzed. A significant increased risk of recurrence (51%) was highlighted for Krouse stage T3 disease when compared with stage T2 (pooled OR, 1.51; 95% CI, 1.09-2.09). No significant difference in risk of recurrence was found between Krouse stages T1 and T2 disease (pooled OR, 1.14; 95% CI, 0.63-2.04) or between stages T3 and T4 (pooled OR, 1.27; 95% CI, 0.72-2.26). Conclusions and Relevance:Inverted papillomas classified as stage T3 according to the Krouse classification system presented a 51% higher likelihood of recurrence. Head and neck surgeons must be aware of this higher likelihood of recurrence when planning and performing surgery for sinonasal inverted papilloma.
Surgical management of inverted papilloma; a single-center analysis of 247 patients with long follow-up.
Bugter Oisín,Monserez Dominiek André,van Zijl Floris Vincent Willem Joseph,Baatenburg de Jong Robert Jan,Hardillo Jose Angelito
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale
BACKGROUND:Our aim was to review our management of inverted papilloma (IP), perform a recurrence analysis, and review the literature. METHODS:A retrospective analysis of 247 patients treated for an IP. Patients were grouped according to surgical approach, tumor presentation (primary, residual and recurrence) and Krouse-stage. RESULTS:Recurrence was observed in 20.3%, 28.6% and 35.1% (p = 0.017) of the patients who underwent endoscopic, external and combined surgery, respectively. Recurrences occurred more often in residual than primary IP (36.9% vs. 22.3%, p = 0.021). Primary endoscopic surgery had a recurrence rate of 12.5%, which was comparable to the recent literature (11.2%, 161/1433). CONCLUSIONS:The relatively high number of recurrences in this cohort is explained by the long follow-up and previous (incomplete) surgery in 61.5% of the cases. The inferior outcome of residual IP underscores the importance of having a low threshold for preoperative biopsy in unilateral and atypical sinonasal disease.
Imaging features of benign mass lesions in the nasal cavity and paranasal sinuses according to the 2017 WHO classification.
Tatekawa Hiroyuki,Shimono Taro,Ohsawa Masahiko,Doishita Satoshi,Sakamoto Shinichi,Miki Yukio
Japanese journal of radiology
The World Health Organization (WHO) 2017 classification of head and neck tumors has been just published and has reorganized tumors of the nasal cavity and paranasal sinuses. In this classification, three new entities (seromucinous hamartoma, NUT carcinoma, and biphenotypic sinonasal sarcoma) were included, while the total number of tumors has been reduced by excluding tumors if they did not occur exclusively or predominantly in this region. Among these entities, benign tumors were classified as sinonasal papillomas, respiratory epithelial lesions, salivary gland tumors, benign soft tissue tumors, or other tumors. In contrast, inflammatory diseases often show tumor-like appearances. The imaging features of these benign tumors and tumor-like inflammatory diseases often resemble malignant tumors, and some benign lesions should be given attention in the follow-up period and before surgery to avoid recurrence, malignant transformation, or massive bleeding. Understanding the CT and MR imaging features of various benign mass lesions is clinically important for appropriate therapy. The purpose of this article is to describe the clinical characteristics and imaging features of each of clinically important nasal and paranasal benign mass lesions, as classified according to the WHO 2017 classification of head and neck tumors, along with some inflammatory diseases.
Prediction of the originating site of sinonasal inverted papilloma by preoperative magnetic resonance imaging and computed tomography.
Fang Gaoli,Lou Hongfei,Yu Wenling,Wang Xiangdong,Yang Bentao,Xian Junfang,Song Xiaohong,Fan Erzhong,Li Ying,Wang Chengshuo,Zhang Luo
International forum of allergy & rhinology
BACKGROUND:Precise localization and excision of the originating site of a sinonasal inverted papilloma (SNIP) is essential for decreasing tumor recurrence. In this study we evaluated the use of preoperative computed tomography (CT) and magnetic resonance imaging (MRI) to pinpoint the attachment/originating sites of SNIPs in 143 patients. METHODS:Osteitis signs in CTs and convoluted cerebriform pattern (CCP)-based reverse tracings from MRIs of 143 SNIP patients were analyzed preoperatively to predict the originating site of SNIPs. The predicted sites were compared with actual SNIP attachment sites determined by surgery, and patients were followed-up for evaluation of SNIP recurrence rates over a mean period of about 4 years. RESULTS:Osteitis signs in CT accurately predicted the actual tumor attachment site in 49.7% of all patients. In comparison, convoluted cerebriform pattern (CCP)-based reverse tracings in MRI and combination CT plus MRI accurately predicted the SNIP originating sites in 84.1% and 86% of the patients, respectively. Sensitivity and specificity in predicting the SNIP originating site were: CT, 54.6% and 69.2%; MRI, 93.1% and 76.9%; and CT+MRI, 94.6% and 92.3%, respectively. A single postoperative recurrence occurred in 4.2% of the patients. CONCLUSIONS:Preoperative combination of MRI and CT provides a better option to accurately predict the SNIP originating site, and thus may facilitate accurate and complete excision of the SNIP.
Predicting the site of attachment of sinonasal inverted papilloma.
Bhalla R K,Wright E D
STATEMENT OF PROBLEM:Sinonasal inverted papilloma is a benign, epithelial neoplasm, which has a propensity for malignant transformation and recurrence. The evolution of endoscopic trans-nasal surgery has facilitated less destructive and, more functionally and cosmetically acceptable approaches to this tumour. Recurrence rates have been shown to be more favourable than after traditional external approaches. Precise surgery is enhanced by pre-operative localisation of the site of tumour attachment. The aim of this study was to examine, in a prospective fashion, the predictive value of osteitis on the pre-operative CT scan of the paranasal sinuses at correctly identifying the site of attachment of sinonasal inverted papilloma. METHOD OF STUDY:Pre-operative CT scans of the paranasal sinuses in 24 patients with histology-proven sinonasal inverted papilloma were examined for osteitis, allowing a prediction of the site of attachment. Coronal reformats of thin-cut (1mm) axial CT scans were evaluated. Intra-operatively, the actual site of tumour attachment was established. A correlation between the predicted and actual site of tumour attachment was calculated. MAIN RESULT:The predictive value of the osteitis sign was 95%. PRINCIPAL CONCLUSION:Pre-operative identification of osteitis can be used in 95% of cases to accurately predict the intra-operative site of attachment of sinonasal inverted papilloma.
Can Computed Tomography Findings Predict the Recurrence of Sinonasal Inverted Papilloma?
Glikson Eran,Dragonetti Alberto,Soudry Ethan,Rozendoren Noa,Landsberg Roee,Bedrin Lev,Mozzanica Francesco,Schneider Shay,Yakirevitch Arkadi
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
OBJECTIVE:To evaluate the correlation between the ability to predict the attachment site of sinonasal inverted papilloma by computed tomography and the long-term surgical outcome. STUDY DESIGN:Retrospective cohort study. SETTING:Five tertiary medical centers. METHODS:Study patients underwent attachment-oriented resection of inverted papilloma. The primary outcome was tumor recurrence. RESULTS:Among 195 patients eligible for the study, focal hyperostosis was recognized on computed tomography in 65% (n = 127), in 71% of primary cases (n = 101), and in 50% of revision procedures (n = 26). There was a trend for a higher incidence of squamous cell carcinoma among the patients without detectable hyperostosis ( = .051). Location of hyperostosis coincided with the actual tumor attachment site in 114 patients (90%). Discordance between these parameters did not differ significantly ( = .463) between 11 primary and 2 revision cases. The overall rate of recurrence was 9.7% (n = 19), with a mean time to recurrence of 20 months (range, 7-96 months). The rate of recurrence did not correlate with any of the following: tumor stage, surgical approach, presence of squamous cell carcinoma, whether the surgery was primary or revision, and the presence or location of focal hyperostosis on computed tomography. Inverted papilloma recurred significantly more often (38.5%) when the intraoperative findings of the tumor attachment site did not match the location of hyperostosis observed on computed tomography (odds ratio, 6.5; 95% CI, 1.78-23.66). CONCLUSION:Detectability of focal hyperostosis on preoperative computed tomography does not affect the long-term outcome of inverted papilloma resection.
Impact of human papillomaviruses (HPV) on recurrence rate and malignant progression of sinonasal papillomas.
Paehler Vor der Holte Anja,Fangk Inger,Glombitza Sabine,Wilkens Ludwig,Welkoborsky Hans J
Sinonasal papillomas are characterized by their potential for frequent recurrences and malignant progression. Currently, the role of human papillomavirus (HPV) infection in sinonasal papillomas is unclear. A study was conducted to elucidate the impact of HPV infection on recurrence and malignant progression of sinonasal papillomas. One hundred and seven patients with 151 tumors could be examined. One hundred and one patients suffered from benign papilloma, mostly inverted papillomas (IP); six patients suffered from carcinomas in situ and squamous cell carcinomas (SCC) ex-IP. Recurrent IP were more often HPV-positive than non-recurrent tumors (38.8% vs. 60%-65%). Low-risk (LR) HPV infection (especially HPV 6) increased the risk of tumor recurrences (p = 0.0385 and p = 0.0556, respectively). IP and oncocytic papillomas (both lesions are known for their malignant potential) were more often high-risk (HR) HPV-positive (15.5% and 16.7%) than fungiform papilloma (which usually does not progress to carcinoma). CIS and SCC ex-IP displayed higher HPV rates than benign IP (83.3% vs. 38.8%), especially higher rates of HR-HPV (66.7% vs. 23.8%, p = 0.0415). Data from this study endorse the hypothesis that recurrence of sinonasal papillomas is promoted by LR-HPV infection and that malignant progression of IP is promoted by HR-HPV infection.
Inferior nasal turbinate mucosa shrinkage prior to surgery under local anaesthesia.
Zagólski Olaf,Stręk Paweł,Lisiecka Małgorzata,Gorzedowski Przemyslaw
Acta otorrinolaringologica espanola
INTRODUCTION AND OBJECTIVES:Chronic rhinitis-related complaints may result from isolated hypertrophy of the inferior nasal turbinates. If the symptoms persist despite conservative management, turbinoplasty is indicated. However, the nasal mucosa lining the inferior turbinates seems decongested immediately before the surgery performed under local anaesthesia, compared to the examination when the patients were entered for surgery. The study aimed to confirm this observation and to hypothesize as to the reasons for its occurrence. PATIENTS AND METHODS:The measurements of the longest distances between the medial rim of the inferior nasal turbinate mucosa and nasal septum and the shortest distances between the lower rim of the turbinate and floor of the nasal cavity in the inferior part of both common nasal meatus, were carried out on photos taken during endoscopic examinations: the one entering the patient for turbinoplasty, and the other immediately before the procedure. The results in this group were compared to those obtained from patients operated on under general anaesthesia. RESULTS:In 130 patients aged 18-60 (mean=40.7) years, operated on under local anaesthesia, the sum of the mean distances between the nasal septum and the medial rim of the lower turbinate in both nasal cavities, was 3.4mm during the first examination, and 4.5mm (p=.0008) during the second one. In the group of 42 participants aged 26-47, mean=36.8 years operated on under general anaesthesia, the values were: 4.8mm and 3.6mm (p=.02), respectively. The differences were significantly smaller in the smokers (.3) compared to non-smokers (1.3; p=.04) mm. CONCLUSIONS:Records of the entering examination must be considered before turbinoplasty under local anaesthesia.
[Microbiology of chronic rhinosinusitis with different clinical phenotypes].
Liu Xiao,Liu Hongbing,Li Chunhua,Wu Wenxia
Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery
To observe the microbiological characteristics and clinical correlation of chronic rhinosinusitis with different clinical phenotypes. One hundred and ninety-six patients with chronic rhinosinusitis（CRS） underwent nasal endoscopic surgery, including 126 patients with Chronic rhinosinusitis with nasal polyps（CRSwNP） and 70 patients with chronic rhinosinusitis without nasal polyps（CRSsNP）; 78 patients with nasal septum deviation（control group） were enrolled. The nasal discharge samples were collected before operation, and the bacteria were isolated and identified by the traditional culture method. The bacteria were compared between the two groups by Pearson chi-square test or Fisher exact test, and the bacteria were compared between groups by Kruskal-Wallis rank sum test. Out statistically significant variables（<0.05）. The total bacterial detection rate was 73.0% in the three groups, 76.2% in the CRSwNP group, 68.6% in the CRSsNP group and 71.8% in the control group, respectively（=0.579）. The detection rate of the bacteria was mainly Gram-positive bacteria. The higher detection rate included: Staphylococcus epidermidis, Pseudodiphtheria, Staphylococcus aureus, Haemophilus influenzaemola, Haemella influenzaemola. The detection rate of Haemophilus influenzae in the CRSwNP group and the control group（13.5% vs 2.6%, =0.009）, but there were statistical differences CRSsNP.There was no statistically significant difference in the detection rate of the bacteria（8.6% vs 2.6%, =0.15） between the CRSsNP group and the control group; The difference of staphylococcus aureus detection rate between NonECRSwNP group and ECRSwNP group was statistically significant （9.6% vs 28.1%,=0.017）.There was no significant difference in staphylococcus aureus detection rate between NonECRSsNP group and ECRSsNP group （9.4% vs 16.7%, =0.482）. Haemophilus influenzae may be a potential cause of CRSwNP; S. aureus may promote the eosinophilic granulocyte inflammatory response to CRSwNP.
Acute isolated sphenoid sinusitis in children: A case series and systematic review of the literature.
Clement W A,Sooby P,Doherty C,Qayyum N,Irwin G
International journal of pediatric otorhinolaryngology
OBJECTIVE:This study aims to present a case series and systematic review of acute isolated sphenoid sinusitis (AISS) in children in order to better characterize clinical presentation, diagnosis, treatment, and outcomes of this condition. DATA SOURCES:Ovid MEDLINE, Pubmed, Embase, Cochrane Library, and Google Scholar. STUDY SELECTION:Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Full-text, peer-reviewed journal publications from 1994 to 2020 in English; focus on acute sphenoid sinusitis; pediatric patients (<18 years of age); series with two or more children. Studies were assessed for data including demographics, presenting symptoms and signs, radiological investigations, treatment, outcomes and complications. RESULTS:Ten studies identifying 71 patients were included. Average age at presentation was 12.0 years (range 5-17 years). M:F ratio 1:1. The most common presenting symptoms were headache (98.6%), fever (50.7%), nasal symptoms (22.5%) ocular symptoms (19.7%) and decreased level of consciousness (12.7%). Twenty patients (28.1%) had neurological signs. Twenty-three patients (32.4%) presented with headache in isolation. Unsuspected diagnosis at presentation was noted in 54.0%. Average time to initial presentation was 14.0 days (median = 5.5 days, range 1-90 days). The majority of children were treated with antibiotics (98.6%) with 31.0%, 2.8% and 2.8% also undergoing sinus surgery, revision sinus surgery and neurosurgery, respectively. Intracranial complications occurred in 16.9% of patients. Significant long term sequelae occurred in 2 children (2.8%) and one death (1.4%) was also reported. LIMITATIONS:All studies were retrospective case note reviews. CONCLUSIONS:Acute sphenoid sinusitis is a rare and difficult condition to diagnose in children. The majority of patients make a full recovery with appropriate treatment. If treatment is delayed however consequences can be life-threatening.