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Guo M, Zang X, Fu W, Yan H, Bao X, Li T, Qiao J. Classification of nasal polyps and inverted papillomas using CT-based radiomics. Insights Imaging 2023; 14:188. [PMID: 37955767 PMCID: PMC10643706 DOI: 10.1186/s13244-023-01536-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/21/2023] [Indexed: 11/14/2023] Open
Abstract
OBJECTIVES Nasal polyp (NP) and inverted papilloma (IP) are two common types of nasal masses. And their differentiation is essential for determining optimal surgical strategies and predicting outcomes. Thus, we aimed to develop several radiomic models to differentiate them based on computed tomography (CT)-extracted radiomic features. METHODS A total of 296 patients with nasal polyps or papillomas were enrolled in our study. Radiomics features were extracted from non-contrast CT images. For feature selection, three methods including Boruta, random forest, and correlation coefficient were used. We choose three models, namely SVM, naive Bayes, and XGBoost, to perform binary classification on the selected features. And the data was validated with tenfold cross-validation. Then, the performance was assessed by receiver operator characteristic (ROC) curve and related parameters. RESULTS In this study, the performance ability of the models was in the following order: XGBoost > SVM > Naive Bayes. And the XGBoost model showed excellent AUC performance at 0.922, 0.9078, 0.9184, and 0.9141 under four conditions (no feature selection, Boruta, random forest, and correlation coefficient). CONCLUSIONS We demonstrated that CT-based radiomics plays a crucial role in distinguishing IP from NP. It can provide added diagnostic value by distinguishing benign nasal lesions and reducing the need for invasive diagnostic procedures and may play a vital role in guiding personalized treatment strategies and developing optimal therapies. CRITICAL RELEVANCE STATEMENT Based on the extraction of radiomic features of tumor regions from non-contrast CT, optimized by radiomics to achieve non-invasive classification of IP and NP which provide support for respective therapy of IP and NP. KEY POINTS • CT images are commonly used to diagnose IP and NP. • Radiomics excels in feature extraction and analysis. • CT-based radiomics can be applied to distinguish IP from NP. • Use multiple feature selection methods and classifier models. • Derived from real clinical cases with abundant data.
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Affiliation(s)
- Mengqi Guo
- School of Physics and Electronics, Shandong Normal University, No. 88, Wenhua East Road, Lixia District, Jinan, Shandong, 250014, China
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, No.619 Chang Cheng Road, Daiyue District, Taian, 271016, Shandong, China
| | - Xuefeng Zang
- School of Physics and Electronics, Shandong Normal University, No. 88, Wenhua East Road, Lixia District, Jinan, Shandong, 250014, China
| | - Wenting Fu
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, No.619 Chang Cheng Road, Daiyue District, Taian, 271016, Shandong, China
| | - Haoyi Yan
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, No.619 Chang Cheng Road, Daiyue District, Taian, 271016, Shandong, China
| | - Xiangyuan Bao
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, No.619 Chang Cheng Road, Daiyue District, Taian, 271016, Shandong, China
| | - Tong Li
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324 Jingwuwei 7Th Road, Huaiyin District, Jinan, Shandong, 250021, China.
| | - Jianping Qiao
- School of Physics and Electronics, Shandong Normal University, No. 88, Wenhua East Road, Lixia District, Jinan, Shandong, 250014, China.
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Park MJ, Cho W, Kim JH, Chung YS, Jang YJ, Yu MS. Preoperative Prediction of Sinonasal Inverted Papilloma-associated Squamous Cell Carcinoma (IP-SCC). Laryngoscope 2023; 133:2502-2510. [PMID: 36683553 DOI: 10.1002/lary.30583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/28/2022] [Accepted: 01/06/2023] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Sinonasal inverted papillomas (IP) can undergo transformation into IP-squamous cell carcinomas (IP-SCC). More aggressive treatment plan should be established when IP-SCC is suspected. Nevertheless, inaccuracy of the preoperative punch biopsy results to detect IP-SCC from IP raises the need for an additional strategy. The present study aimed to investigate significant clinicoradiological remarks associated with IP-SCC than IP. MATERIAL AND METHODS Postoperative surgical specimens obtained from patients with confirmed IP or IP-SCC at a single tertiary medical center from 1997 to 2018 were retrospectively evaluated. Patients' demographic and clinical characteristics, preoperative in-office punch biopsy results, and preoperative computed tomography (CT) or magnetic resonance images were reviewed. Univariate and multivariate analyses were performed to assess the odds ratio (OR) associated with IP-SCC. The area under the curve (AUC) in the receiver Operating Characteristic (ROC) curve was calculated in the prediction model to discriminate IP-SCC from IP. RESULTS The study included 44 IP-SCC and 301 patients with IP. The diagnostic sensitivity of in-office punch biopsy to detect IP-SCC was 70.7%. Multivariate analysis showed that factors significantly associated with IP-SCC included tobacco smoking >10PY (adjusted-OR [aOR]: 4.1), epistaxis (aOR: 3.4), facial pain (aOR: 4.2), bony destruction (aOR: 37.6), bony remodeling (aOR: 36.3), and invasion of adjacent structures (aOR: 31.6) (all p < 0.05). Combining all significantly related clinicoradiological features, the ability to discriminate IP-SCC from IP reached an AUC of 0.974. CONCLUSION IP patients with a history of tobacco smoking, facial pain, epistaxis, and bony destruction, remodeling, or invasion of an adjacent structure on preoperative images may be at higher risk for IP-SCC. LEVEL OF EVIDENCE 3 Laryngoscope, 133:2502-2510, 2023.
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Affiliation(s)
- Marn Joon Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Inha University Medical Center, Inha University School of Medicine, Incheon, South Korea
| | - Wonki Cho
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ji Heui Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yoo-Sam Chung
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yong Ju Jang
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Myeong Sang Yu
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Zhang Z, Yu L, Jiang J, Wang L, Zhou S, Hao D, Jiang Y. Development and Validation of a Clinical Prediction Model to Diagnose Sinonasal Inverted Papilloma Based on Computed Tomography Features and Clinical Characteristics. EAR, NOSE & THROAT JOURNAL 2022:1455613221134421. [PMID: 36264012 DOI: 10.1177/01455613221134421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: Sinonasal inverted papilloma (SNIP) is one of the most common benign tumors of the nasal cavity and sinuses and is at risk for recurrence and malignant transformation. It is crucial to precisely predict SNIP before surgery to determine the optimal surgical technique and prevent SNIP recurrence. This study aimed to evaluate the diagnostic value of computed tomography (CT) features and SNIP clinical characteristics and to develop and validate a clinically effective nomogram. Methods: Here, 267 patients with SNIP and 273 with unilateral chronic rhinosinusitis with/without nasal polyps were included. Patient's demographic and clinical characteristics (i.e., gender, age, nasal symptoms, history of sinus surgery, smoking, and alcohol dependence) and CT features (i.e., lobulated/wavy edge, air sign, focal hyperostosis, diffuse hyperostosis, focal osseous erosion, and CT values) were recorded. Independent risk factors were screened using logistic regression analysis. A nomogram model was developed and validated. Results: Logistic regression analysis showed that age, facial pain/headache, history of sinus surgery, lobulated/wavy edge, air sign, focal hyperostosis, focal osseous erosion, and CT values were independent predictors of SNIP. A nomogram comprising these 8 independent risk factors was established. The area under the curve (AUC) for the training set was .960 (95% CI, .942-.978) and the AUC for the validation set was .951 (95% CI, .929-.971). Conclusion: The obtained results suggested that the nomogram based on age, facial pain/headache symptoms, history of sinus surgery, and CT characteristics had an excellent diagnostic value for SNIP.
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Affiliation(s)
- Zengxiao Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- Department of Medicine, Qingdao University, Qingdao, China
| | - Longgang Yu
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jiaxin Jiang
- Lifescience Department of Faculty of Health Science, Queen's University, Kingston, Ontario, Canada
| | - Lin Wang
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shizhe Zhou
- Department of Medicine, Qingdao University, Qingdao, China
| | - Dapeng Hao
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yan Jiang
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- Otorhinolaryngology Head and Neck Surgery Key Laboratory of Shandong Province, Qingdao, China
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Inverted papilloma and nasal polyp classification using a deep convolutional network integrated with an attention mechanism. Comput Biol Med 2022; 149:105976. [DOI: 10.1016/j.compbiomed.2022.105976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 07/18/2022] [Accepted: 08/13/2022] [Indexed: 11/18/2022]
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Numano Y, Nomura K, Sugawara M, Hemmi T, Suzuki J, Kakuta R, Katori Y. Sinonasal Inverted Papilloma Showing a Misleading Finding on Magnetic Resonance Imaging. EAR, NOSE & THROAT JOURNAL 2022:1455613221095614. [PMID: 35485578 DOI: 10.1177/01455613221095614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Sinonasal inverted papilloma (IP) is the most common benign tumor in sinonasal cavities. Treatment involves excising the whole tumor, so it is essential to evaluate the extent of the tumor by preoperative radiographic findings. Magnetic resonance imaging (MRI) is superior to computed tomography (CT) for determining a tumor's location as MRI can discern the difference between mucus and IP. We herein report a 51-year-old man with sinonasal IP treated with endoscopic sinus surgery (ESS). Preoperative MRI showed findings resembling a convoluted cerebriform pattern on T2-weighted imaging, but this site was not enhanced by intravenous gadolinium at all. We preoperatively suspected that this site was not part of the tumor but rather the accumulation of mucus, and indeed, we found no tumor at this site when we performed the surgery. This patient is a valuable example of misleading findings of IP on T2-weighted imaging and underscores the importance of contrast-enhanced T1-weighted imaging to determine the extent of IP.
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Affiliation(s)
- Yuki Numano
- Department of Otolaryngology, 38185Tohoku Kosai Hospital, Sendai-shi, Miyagi, Japan
| | - Kazuhiro Nomura
- Department of Otolaryngology, 38185Tohoku Kosai Hospital, Sendai-shi, Miyagi, Japan
| | - Mitsuru Sugawara
- Department of Otolaryngology, 38185Tohoku Kosai Hospital, Sendai-shi, Miyagi, Japan
| | - Tomotaka Hemmi
- Department of Otolaryngology, Head and Neck Surgery, 73819Tohoku University Hospital, Sendai-shi, Miyagi, Japan
| | - Jun Suzuki
- Department of Otolaryngology, Head and Neck Surgery, 73819Tohoku University Hospital, Sendai-shi, Miyagi, Japan
| | - Risako Kakuta
- Department of Otolaryngology, Head and Neck Surgery, 73819Tohoku University Hospital, Sendai-shi, Miyagi, Japan
| | - Yukio Katori
- Department of Otolaryngology, Head and Neck Surgery, 73819Tohoku University Hospital, Sendai-shi, Miyagi, Japan
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Sano N, Kikuta S, Kondo K, Yamasoba T. High CT values relative to the brainstem differentiate inverted papillomas from nasal polyps. Auris Nasus Larynx 2021; 48:905-913. [PMID: 33810925 DOI: 10.1016/j.anl.2021.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/09/2021] [Accepted: 02/16/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES A diagnostic indicator for the differentiation of inverted papillomas (IPs) from inflammatory nasal polyps (NPs) has not been established. This study aimed to evaluate whether CT attenuation values relative to those of the brainstem (relative CT number) could be useful for differentiating IPs from NPs. MATERIAL AND METHODS Consecutive patients who were pathologically diagnosed with IP or NP between 2005 and 2019 were retrospectively identified. Relative CT numbers were compared between the two patient groups. The factors with predictive power for differentiating IPs from NPs were identified by univariate and multivariate logistic regression analyses. RESULTS One hundred and twenty-two sinonasal masses were finally analysed (IP, 51 cases; NP, 71 cases). Relative CT numbers were significantly higher in IP than in NP (P < 0.001). Univariate logistic regression analysis showed relative CT number, bone erosion and bone thickening to have predictive value for differentiating IPs from NPs (relative CT number, P < 0.001; bone erosion, p = 0.04; bone thickening, P < 0.001). In the multivariate logistic regression analysis, relative CT number and bone thickening had predictive value for distinguishing IP from NP (relative CT number, p < 0.001; bone thickening, p = 0.02). The optimum cut off value calculation from the area under the receiver operating characteristics curve indicated that a relative CT number >1.3 was significantly associated with IP (sensitivity, 72.6%; specificity, 87.3%). Within cases not showing bone thickening, only the relative CT number was a predictive factor for differentiating IPs from NPs in the univariate analysis. CONCLUSIONS High relative CT numbers could potentially indicate IP, and their measurement could provide a basis for differentiating IPs from NPs.
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Affiliation(s)
- Nao Sano
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Shu Kikuta
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Kenji Kondo
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Eid M, Eissa L. Imaging of sino-nasal inverted papilloma: How can we emphasize the usefulness of the “striated pattern” sign? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-0134-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Inverted papilloma (IP) is an uncommon sino-nasal neoplasm with potentially distinctive MRI and CT features. The MR “striated” imaging pattern has been reported as a valuable MR imaging feature of IP. The purpose of this study was to validate the usefulness of this sign using detailed criteria of the sign itself.
Results
All imaging findings were described for 16 patients in descriptive pattern. The nasal involvement showed highest prevalence followed by the maxillary sinus. The bony changes include remodeling and defects (n = 6), remodeling only (n = 4), and None (n = 6). Changes were severe 1/10, moderate in 3/10, and mild 5/10. Focal hyperostosis was seen in six. A striated pattern was “diffuse” in all 16 (100%) of the IPs; it followed a certain direction in all 16 patients: divergent (n = 6), convoluted (n = 2), and parallel (n = 8). Divergent growth from focal hyperostosis was seen (n = 4). Visibility of the sign was superior in T2 images (n = 11), superior in enhanced images (n = 3), and equal in both (n = 2).
Conclusions
The striated pattern is a reliable MR imaging feature of sino-nasal IPs. Validity and usefulness of this sign can be emphasized by defining parameters of the signs itself including the following: diffusivity, direction of striations and relation to hyperostosis, and comparing visibility in both T2 and GAD-enhanced images, as well as combining this imaging signature with remolding bony changes < 1.5.
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Russo C, Elefante A, Romano A, Cama A, Erra M, Ugga L, Brunetti L, Motta G, Califano L, Iengo M, Cantone E. A multimodal diagnostic approach to inverted papilloma: Proposal of a novel diagnostic flow-chart. Curr Probl Diagn Radiol 2020; 50:499-504. [PMID: 32540138 DOI: 10.1067/j.cpradiol.2020.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 03/28/2020] [Accepted: 04/14/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE Inverted papilloma (IP) is a tumor usually arising from sinonasal cavities, with tendency for recurrence and possible malignant transformation. Along with endoscopy, computed tomography (CT) and magnetic resonance imaging (MRI) play a crucial role in defining preoperative staging, tumor origin, and possible differential diagnosis, with significant repercussions on therapeutic planning. However, at present no consensus has been reached concerning IP diagnostic workup. Aim of this study is to assess CT and MRI sensitivity and specificity in identifying IP imaging hallmarks, evaluating their global diagnostic accuracy in order to define a novel diagnostic flowchart. METHODS We retrospectively analyzed multimodal imaging of patients with histologically confirmed IP and mimics. Two neuroradiologists in consensus retrospectively rated the presence of typical imaging features of IP, both on CT and MRI scans. Sensitivity, specificity and diagnostic accuracy were assessed for both the techniques. Final results were expressed as ROC curves and relative areas under the curve (AUC). RESULTS The AUC considering CT parameters were 0.42, whereas the AUC considering MRI parameters were 0.54. Combining the 2 techniques and limiting the evaluation to the most distinctive features such as focal hyperostosis and CCP, the AUC was 0.79. CONCLUSION MRI can provide better tissue characterization and higher diagnostic accuracy in case of suspected IP, whereas CT is more useful in determining bony involvement. Here we propose a possible diagnostic flowchart for IP, based on the assumption that the combination of the imaging techniques allows to optimize the clinical assessment and the subsequent therapeutic planning.
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Affiliation(s)
- Camilla Russo
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy.
| | - Andrea Elefante
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Antonio Romano
- Department of Neurosciences, Reproductive and Odontostomatological Sciences - Division of Maxillofacial Surgery, University "Federico II", Naples, Italy
| | - Antonia Cama
- Department of Neurosciences, Reproductive and Odontostomatological Sciences - Division of Maxillofacial Surgery, University "Federico II", Naples, Italy
| | - Maurizio Erra
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Lisa Brunetti
- Department of Radiology, Università Vita-Salute San Raffaele, Milano, Italy
| | - Gaetano Motta
- Otorhinolaryngology, Head and Neck Surgery Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Luigi Califano
- Department of Neurosciences, Reproductive and Odontostomatological Sciences - Division of Maxillofacial Surgery, University "Federico II", Naples, Italy
| | - Maurizio Iengo
- Department of Neuroscience, Reproductive and Odontostomatological Sciences - ENT section, University "Federico II", Naples, Italy
| | - Elena Cantone
- Department of Neuroscience, Reproductive and Odontostomatological Sciences - ENT section, University "Federico II", Naples, Italy
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Brown CS, Abi Hachem R, Pendse A, Madden JF, Francis HW. Low-Grade Papillary Schneiderian Carcinoma of the Sinonasal Cavity and Temporal Bone. Ann Otol Rhinol Laryngol 2018; 127:974-977. [PMID: 30269519 DOI: 10.1177/0003489418803391] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES: The aim of this study was to further characterize a newly described neoplasm, low-grade papillary Schneiderian carcinoma, occurring simultaneously in the sinonasal cavity and mastoid. Additionally, the authors review the only 2 similar cases within the literature and describe the common clinical features, radiographic findings, and pathologic characteristics of this exceptionally rare disease process. METHODS: Chart review for single patient, review of literature. RESULTS: The patient presented with bilateral nasal obstruction. Computed tomography revealed a left sinonasal mass with skull base hyperostosis, and follow-up magnetic resonance imaging showed a concomitant olfactory groove meningioma. Examination showed a bilateral, completely obstructing sinonasal mass with skip areas, and biopsy confirmed inverted papilloma (human papilloma virus strains 16 and 18 indeterminate). The patient underwent bilateral endoscopic sinus surgery, left medial maxillectomy, and left partial nasopharyngectomy. Given her multifocal disease, she was advised that she would require additional excision, but was lost to follow up. One year later she developed acute left facial paralysis. Magnetic resonance imaging demonstrated an enhancing mass in the left mastoid with enhancement along the Eustachian tube in addition to her known recurrent sinonasal disease. Simultaneous endoscopic sinus surgery and mastoidectomy were performed. Polypoid tissue was removed from the nasopharynx, mesotympanum, epitympanum, and retrofacial air cells. Immunohistochemistry showed that cells stained positive for p63 and dermCK and negative for synaptophysin. Morphologically, cells were bland, without classic stromal invasion, retaining their smooth, cystic, and papillary features, despite their increased depth within the tissue. Upon further review and consultation with an outside pathologist, a diagnosis of low-grade papillary Schneiderian carcinoma was made. The patient was referred for radiation therapy and is disease free at 3-month follow-up, with return of her facial function. CONCLUSIONS: This case represents the first report of concurrent low-grade papillary Schneiderian carcinoma of both the nasal cavity and mastoid. It emphasizes the importance of recognizing this new entity through pathologic analysis and suspecting it when the clinical course does not follow an expected pattern.
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Affiliation(s)
- C Scott Brown
- 1 Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Ralph Abi Hachem
- 1 Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Avani Pendse
- 2 Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - John F Madden
- 2 Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Howard W Francis
- 1 Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, NC, USA
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Sinonasal papilloma: what influences the decision to request a magnetic resonance imaging scan? The Journal of Laryngology & Otology 2018; 132:584-590. [PMID: 29909780 DOI: 10.1017/s0022215118000804] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Computed tomography is the standard pre-operative imaging modality for sinonasal papilloma. The complementary use of magnetic resonance imaging as an additional investigation is debated. This study aimed to establish whether magnetic resonance imaging can accurately detect tumour extent and is a useful adjunct to computed tomography. METHODS A retrospective review was conducted on 19 patients with sinonasal papilloma. The interpretation of computed tomography and magnetic resonance imaging scans, by three clinicians, was conducted by comparing prediction of tumour extent. The perceived necessity of magnetic resonance imaging was compared between clinicians. RESULTS The addition of magnetic resonance imaging improved accuracy of pre-operative interpretation; specifically, this finding was significant in cases with frontal sinus involvement. Surgeons were more likely than a radiologist to request magnetic resonance imaging, particularly when computed tomography indicated frontal sinus disease. CONCLUSION Pre-operative combined magnetic resonance imaging and computed tomography helped predict disease in the frontal sinus better than computed tomography alone. A close working relationship between the ENT and radiology departments is important for accurate tumour localisation.
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Miyazaki T, Haku Y, Yoshizawa A, Iwanaga K, Fujiwara T, Mizuta M, Yoshida A, Satou S, Tamaki H. Clinical features of nasal and sinonasal inverted papilloma associated with malignancy. Auris Nasus Larynx 2018; 45:1014-1019. [PMID: 29548524 DOI: 10.1016/j.anl.2018.02.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 02/16/2018] [Accepted: 02/27/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Nasal and sinonasal inverted papilloma (IP) are rare benign tumors and have the potential to exhibit malignancy in approximately 10% of cases. This study aimed to analyze the clinical features of IP associated with malignancy. Furthermore, we reviewed our therapeutic strategy and the clinical course of malignant IP. METHODS Overall, 70 patients with IP at our institution were retrospectively analyzed from April 2006 to December 2015; of these, six (9%) had associated malignancy. Data was collected on sex, age, presenting symptoms (nasal bleeding, rhinorrhea, facial or cheek pain, and nasal obstruction), bone destruction, and extent of disease on CT and MRI. Categorical data of patients with and without malignancy were compared using the chi-square test. A p value of <0.05 was considered statistically significant. Our therapeutic strategy for IP with malignancy, particularly the surgical procedure, i.e., the external incision or the endoscopic nasal approach, varied based on when the carcinoma was detected. In addition, we considered postoperative radiation therapy depending on histological examination. RESULTS Nasal bleeding (p<0.001), pain (p=0.040), bone destruction (p<0.001), and extent of disease (p=0.026) on CT and MRI findings were significantly associated with malignancy. Carcinoma was diagnosed preoperatively in two (33%) and postoperatively in four patients (67%). We operated five patients (one case was not treated because of end-stage pancreatic cancer). Two patients underwent endoscopic sinus surgery (ESS) alone, two ESS plus Denker's method, and one ESS plus anterior craniotomy. Three patients underwent surgery only, and two patients received postoperative radiotherapy. The median follow-up period was 69.3 months. One patient died of the disease and the remaining patients are alive without recurrence. CONCLUSION For IP patients exhibiting these clinical findings preoperatively, we should suspect complication with malignancy and plan a treatment. Even if postoperative histology does not confirm malignancy, we should ensure careful observation because of metachronous malignant transformation or the possibility to overlook small malignant lesions. Our result suggests that our strategy for malignant IP could be a reasonable option.
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Affiliation(s)
- Takuya Miyazaki
- Department of Otolaryngology, Head and Neck Surgery, Kurashiki Central Hosipital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan.
| | - Yasuharu Haku
- Department of Otolaryngology, Head and Neck Surgery, Kurashiki Central Hosipital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Akira Yoshizawa
- Department of Otolaryngology, Head and Neck Surgery, Kurashiki Central Hosipital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Ken Iwanaga
- Department of Otolaryngology, Head and Neck Surgery, Kurashiki Central Hosipital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Takashi Fujiwara
- Department of Otolaryngology, Head and Neck Surgery, Kurashiki Central Hosipital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Masanobu Mizuta
- Department of Otolaryngology, Head and Neck Surgery, Kurashiki Central Hosipital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Atsuhiro Yoshida
- Department of Otolaryngology, Head and Neck Surgery, Kurashiki Central Hosipital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Shinichi Satou
- Department of Otolaryngology, Head and Neck Surgery, Kurashiki Central Hosipital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Hisanobu Tamaki
- Department of Otolaryngology, Head and Neck Surgery, Kurashiki Central Hosipital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
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Sinonasal Papillomas in a Private Referral Otorhinolaryngology Centre: Review of 22 Years Experience. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017. [DOI: 10.1016/j.otoeng.2017.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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13
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Liang N, Huang Z, Liu H, Xian J, Huang Q, Zhou B. Bone involvement: Histopathological evidence for endoscopic management of sinonasal inverted papilloma. Laryngoscope 2017; 127:2703-2708. [DOI: 10.1002/lary.26659] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/03/2017] [Accepted: 03/31/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Na Liang
- Department of Otolaryngology-Head and Neck Surgery; Capital Medical University; Beijing People's Republic of China
| | - Zhenxiao Huang
- Department of Otolaryngology-Head and Neck Surgery; Capital Medical University; Beijing People's Republic of China
| | - Honggang Liu
- Department of Pathology; Capital Medical University; Beijing People's Republic of China
| | - Junfang Xian
- Department of Radiology; Capital Medical University; Beijing People's Republic of China
| | - Qian Huang
- Department of Otolaryngology-Head and Neck Surgery; Capital Medical University; Beijing People's Republic of China
| | - Bing Zhou
- Department of Otolaryngology-Head and Neck Surgery; Capital Medical University; Beijing People's Republic of China
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de Sousa Fontes A, Sandrea Jiménez M, Urdaneta Lafée N, Abreu Durán PA, Quintana Páez LE, de Sousa de Abreu AC. Sinonasal papillomas in a private referral otorhinolaryngology centre: Review of 22 years experience. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016; 68:251-261. [PMID: 27993194 DOI: 10.1016/j.otorri.2016.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 08/31/2016] [Accepted: 09/09/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To evaluate the clinical presentation, treatment outcome and follow-up of all patients managed with sinonasal papillomas (SP), at a tertiary private otorhinolaryngology centre in Caracas (Venezuela). MATERIAL AND METHODS We reviewed 94 patients with SP that were treated at our otolaryngology center, from July 1st 1993 to June 31st 2015. The demographic data, clinical features, radiological findings, anatomical origin, disease extension into the adjacent structures, surgical approaches performed, histopathology outcomes, recurrent risk, malignant transformation rate and coadjuvant therapies were assessed. RESULTS Sixty-five patients (69.1%) were male and 29 (30.9%) female with an average age of 44.5 years (range 9-80 years). All patients underwent endoscopic sinus surgery. The most commont histologic subtypes of SP were inverted papilloma (58 patients; 61.7%), fungiform papilloma (35 patients; 37.2%) and oncocytic papilloma (one patient; 1.1%). SP was associated in 2 patients with undifferentiated squamous cell carcinoma. Twelve patients (12.8%) had disease with extension beyond the sinus without associated malignancy. All these patients received adjuvant treatment with advanced techniques of radiotherapy. The mean duration of the follow-up period was 9 years and 2 months. Eighteen patients (19.1%) had recurrent disease during the entire course of follow-up. CONCLUSIONS Complete endoscopic surgical removal of SP is the treatment of choice. In less endoscopically accessible tumours, with peripheral extension or incompletely resected, Intensity Modulated Radiotherapy and Volumetric Modulated Arc Therapy may be indicated. Timely post-operative endoscopic follow-up with biopsy of suspected lesions is important for early detection of recurrences and associated malignancy.
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Affiliation(s)
- Aderito de Sousa Fontes
- Unidad de Otorrinolaringoendoscopia, Instituto Médico La Floresta, Unidad Interdisciplinaria de Cirugía Endoscópica de base de cráneo, Post-grado de Neurocirugía, Hospital Militar Dr. Carlos Arvelo, Caracas, Venezuela.
| | - Minaret Sandrea Jiménez
- Instituto Médico La Floresta, Cátedra de Histología y Embriología, Escuela de Medicina Luis Razetti, Universidad Central de Venezuela, Caracas, Venezuela
| | - Nelson Urdaneta Lafée
- Unidad de Radioterapia Oncológica y Medicina Nuclear, Instituto Médico La Floresta, Smilow Cancer Hospital y Yale Cancer Center, Yale University, EE. UU., Cátedra de Radioterapia y Medicina Nuclear, Hospital Universitario UCV, Universidad Central de Venezuela, Caracas, Venezuela
| | | | - Liwven E Quintana Páez
- Equipo Interdisciplinario de Cirugía Endoscópica de base de cráneo, Instituto Médico La Floresta, Postgrado de Neurocirugía, Hospital Militar Dr. Carlos Arvel, Caracas, Venezuela
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Inverted Papilloma Originating Primarily from the Nasolacrimal Duct: A Case Report and Review of the Pertinent Literature. Case Rep Otolaryngol 2015; 2015:123694. [PMID: 26649215 PMCID: PMC4663298 DOI: 10.1155/2015/123694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 10/29/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction. Inverted papilloma (IP) is an uncommon, benign yet aggressive neoplasm characterised by high recurrence rates and tendency towards malignant transformation. The majority of IP cases originate in the ethmoid region, lateral wall of the nasal fossa, and maxillary sinus. The authors report a case of an IP originating primarily from the nasolacrimal duct (NLD). Case. A 69-year-old Caucasian gentleman presented with a lump in his right medial canthal region, epiphora, and discharge bilaterally. Radiological investigation revealed a well-defined, heterogeneous mass within the proximal NLD eroding the bony canal, protruding into the middle meatus and into the right orbit. The tumour was excised en bloc utilizing a combined external and endoscopic approach based on its location. Histology revealed hyperplastic ribbons of basement membrane-enclosed epithelium growing endophytically into the underlying stroma with no evidence of invasive malignancy. The patient made an uneventful recovery with unchanged visual acuity and normal extraocular movements. Conclusion. The case demonstrates variability within the sinonasal tract that IP can develop and the individuality of each case necessitating tailored operative techniques for complete excision whilst minimising recurrence rates. We also present a combined endoscopic approach for the en bloc resection of a NLD IP with no clinical recurrence at 15-month follow-up.
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Nose biopsy: a comparison between two sampling techniques. Eur Arch Otorhinolaryngol 2015; 273:1445-8. [PMID: 26319275 DOI: 10.1007/s00405-015-3754-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 08/13/2015] [Indexed: 10/23/2022]
Abstract
Pre operative biopsy is important in obtaining preliminary information that may help in tailoring the optimal treatment. The aim of this study was to compare two sampling techniques of obtaining nasal biopsy-nasal forceps and nasal scissors in terms of pathological results. Biopsies of nasal lesions were taken from patients undergoing nasal surgery by two techniques- with nasal forceps and with nasal scissors. Each sample was examined by a senior pathologist that was blinded to the sampling method. A grading system was used to rate the crush artifact in every sample (none, mild, moderate, severe). A comparison was made between the severity of the crush artifact and the pathological results of the two techniques. One hundred and forty-four samples were taken from 46 patients. Thirty-one were males and the mean age was 49.6 years. Samples taken by forceps had significantly higher grades of crush artifacts compared to those taken by scissors. The degree of crush artifacts had a significant influence on the accuracy of the pre operative biopsy. Forceps cause significant amount of crush artifacts compared to scissors. The degree of crush artifact in the tissue sample influences the accuracy of the biopsy.
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Wassef SN, Batra PS, Barnett S. Skull base inverted papilloma: a comprehensive review. ISRN SURGERY 2012; 2012:175903. [PMID: 23346418 PMCID: PMC3549337 DOI: 10.5402/2012/175903] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Accepted: 10/17/2012] [Indexed: 11/23/2022]
Abstract
Skull base inverted papilloma (IP) is an unusual entity for many neurosurgeons. IP is renowned for its high rate of recurrence, its ability to cause local destruction, and its association with malignancy. This paper is a comprehensive review of the reports, studies, and reviews published in the current biomedical literature from 1947 to September 2010 and synthesize this information to focus on its potential invasion to the base of the skull and possible intradural extension. The objective is to familiarize the clinician with the different aspects of this unusual disease. The role of modern diagnostic tools in medical imaging in order to assess clearly the limits of the tumors and to enhance the efficiency and the safety in the choice of a surgical approach is pointed out. The treatment guidelines for IP have undergone a complex evolution that continues today. Radical excision of the tumour is technically difficult and often incomplete. Successful management of IP requires resection of the affected mucosa which could be achieved with open surgery, endoscopic, or combined approach. Radio and chemotherapy were used for certain indications. More optimally research would be a multicenter randomized trials with large size cohorts.
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Affiliation(s)
- Shafik N Wassef
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA ; McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada H3A 2B4 ; Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada H3A 2B4
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Carta F, Blancal JP, Verillaud B, Tran H, Sauvaget E, Kania R, Herman P. Surgical management of inverted papilloma: approaching a new standard for surgery. Head Neck 2012; 35:1415-20. [PMID: 23002029 DOI: 10.1002/hed.23159] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inverted papilloma surgery is currently performed primarily with an endoscopic approach, a technique that has a recurrence rate of 12%. However, a recent study reported a recurrence rate of 5% with a strategy based on subperiosteal dissection of the tumor, with limited indications for using an external approach. The aim of this work was to evaluate whether different teams using the same surgical concepts could reproduce the excellent results that were recently reported. METHODS This study is a retrospective chart review of 71 consecutive patients with inverted papilloma who were treated during the last 10 years. RESULTS In all, 80% of the patients were treated using a purely endoscopic approach. The mean follow-up period was 31.6 months. The recurrence rate was 3.3% for cases with at least a 12-month follow-up. CONCLUSIONS This work confirms the results described in recent literature and further supports transnasal endoscopic surgery to manage inverted papilloma.
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Affiliation(s)
- Filippo Carta
- Assistance Publique-Hôpitaux de Paris, Department of Ear, Nose and Throat, Hôpital Lariboisière, Université Paris-Diderot, Paris, France
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Pitak-Arnnop P, Bertolini J, Dhanuthai K, Hendricks J, Hemprich A, Pausch NC. Intracranial extension of Schneiderian inverted papilloma: a case report and literature review. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2012; 10:Doc12. [PMID: 22737105 PMCID: PMC3380239 DOI: 10.3205/000163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Indexed: 11/30/2022]
Abstract
Inverted papilloma is an uncommon primary nasal tumor. Despite its benign nature, this tumor represents three typical characteristics: a high propensity of recurrence, local aggressiveness and association with malignancy. Inverted papilloma can reduce the patient’s quality of life due to compromised nasal function, extension to the orbit and brain. The authors reported the unusual case of a 72-year-old male patient with inverted papilloma, which fatally extended to the intracranial temporal fossa after multiple recurrences. To the authors’ knowledge, this is the twelfth case in the literature of inverted papilla extending into the temporal fossa. The current and pertinent literature in English, French and German was reviewed, and an algorithm for managing inverted papilloma was also proposed.
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Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, University Hospital of Leipzig, Leipzig, Germany.
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2011; 19:58-65. [PMID: 21233627 DOI: 10.1097/moo.0b013e32834344aa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE OF REVIEW The aim of this work, based on a recent review of the literature concerning sinonasal inverted papilloma, is to describe the diagnostic strategy for inverted papilloma and to propose an algorithm for the choice of surgical techniques, based on recent results of clinical series. RECENT FINDINGS Traditionally, inverted papilloma was managed through an open approach. Endoscopic techniques have been developed, first combined with an open approach, and then exclusively endoscopic with the advent of medial maxillectomy and median drainage or Draf procedures. Numerous case series strongly support that they now represent the treatment modality of choice. SUMMARY This is a review concerning recent findings about inverted papilloma, based on recent literature revision.Diagnosis of inverted papilloma has to be made before surgery, and planning of the surgical strategy is based on the comparison of computed tomography and MRI, with the aim of targeting the insertion of the tumor. With the help of expanded surgical procedures, endoscopic surgery has become the gold standard for the treatment of the vast majority of inverted papilloma. In case of massive frontal or supraorbital extensions, the frontal osteoplastic flap is the complementary approach of choice.
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Bilateral inverted papilloma: A report of two cases and review of the current literature. Indian J Otolaryngol Head Neck Surg 2010; 62:313-6. [PMID: 23120732 DOI: 10.1007/s12070-010-0079-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Inverted papilloma is locally aggressive tumour which typically presents as a unilateral nasal polyp. Whilst it has a malignant potential it rarely transforms and in its benign form the main concern originates from its locally aggressive nature and substantial propensity to recur. Bilateral disease can also be due to inverted papilloma, sometimes due to direct extension of the tumour, but it can also occur as two distinct lesions. Here we report two cases of bilateral involvement, review the current literature and highlight some important issues on the management and follow-up of this well known neoplasm.
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Han MW, Lee BJ, Jang YJ, Chung YS. Clinical value of office-based endoscopic incisional biopsy in diagnosis of nasal cavity masses. Otolaryngol Head Neck Surg 2010; 143:341-7. [PMID: 20723769 DOI: 10.1016/j.otohns.2010.05.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 04/21/2010] [Accepted: 05/14/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate clinical features and the diagnostic accuracy of office-based endoscopic incisional biopsy in patients with nasal cavity masses. STUDY DESIGN Diagnostic test assessment with chart review. SETTING Tertiary referral center. SUBJECTS AND METHODS From January 1997 to August 2006, preoperative diagnosis was achieved using endoscopic incisional biopsy in 521 patients. Cytopathologic and histologic findings were categorized as malignancy, benign neoplasm, or non-neoplastic lesion. Preoperative imaging was done in 462 patients (computed tomography: 438 cases; magnetic resonance imaging: 24 cases). We investigated the accuracy of endoscopic incisional biopsy and preoperative imaging by comparing it with pathologic results from tumor resection as the "gold standard." RESULTS Most of the patients had unilateral nasal symptoms (e.g., nasal obstruction, unilateral epistaxis, unilateral facial pain), and the clinical symptoms were of little diagnostic value in the differentiation of tumor and inflammatory lesion. The sensitivity and specificity of endoscopic incisional biopsy were 43.7 and 98.9 percent, respectively, for the diagnosis of nasal cavity malignancies, and 78.2 and 96.2 percent, respectively, for the diagnosis of benign neoplasms. The sensitivity and specificity of preoperative imaging were 78.3 and 97.5 percent, respectively, for the diagnosis of nasal cavity malignancies and 66.4 and 86.3 percent, respectively, for the diagnosis of benign neoplasms. Combining the two modalities increased diagnostic accuracy in nasal cavity masses. CONCLUSION Endoscopic incisional biopsy alone did not ensure accurate diagnosis of nasal cavity tumors, but in combination with preoperative imaging it was helpful for the diagnosis of nasal cavity malignancies.
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Affiliation(s)
- Myung Woul Han
- Department of Otolaryngology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
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