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Talati V, Baird AM, Gattuso P, Allen-Proctor M, Papagiannopoulos P, Batra PS, Filip P, Tajudeen BA. Histopathology of Recalcitrant Maxillary Sinusitis Necessitating Endoscopic Medial Maxillectomy. Laryngoscope 2024; 134:2646-2652. [PMID: 38174761 DOI: 10.1002/lary.31262] [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: 10/30/2023] [Revised: 12/03/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVES Endoscopic medial maxillectomy (EMM) is an effective intervention for patients with recalcitrant maxillary sinusitis after previous middle meatal antrostomy. The pathophysiology of refractory maxillary sinusitis is incompletely understood. We aim to identify trends in structured histopathology (SHP) to better understand how tissue architecture changes contribute to refractory sinusitis and impaired mucociliary clearance. METHODS All patients who underwent EMM or standard maxillary antrostomy for recalcitrant maxillary sinusitis of various forms were included. Retrospective chart review was conducted to collect information on demographics, disease characteristics, comorbid conditions, culture data, and SHP reports. Chi-squared and logistic regression analyses were performed for SHP variables. RESULTS Forty-one patients who underwent EMM and 464 patients who underwent maxillary antrostomy were included. On average, the EMM cohort was 10 years older (60.9 years vs. 51.1 years; p = 0.001) and more often had a history of prior sinus procedures (73.2% vs. 40.9%; p < 0.001). EMM patients had higher rates of fibrosis (34.1% vs. 15.1%, p = 0.002), and this remained statistically significant when controlling for prior sinus procedures and nasal polyposis (p = 0.001). Cultures positive for pseudomonas aeruginosa (38.2% vs. 5.6%, p < 0.001) and coagulase negative staphylococcus (47.1% vs. 23.5%, p = 0.003) were more prevalent in the EMM group. CONCLUSION Fibrosis and bacterial infections with Pseudomonas and coagulase negative Staphylococcus were more prevalent in patients requiring EMM. This may contribute to the multifactorial etiology of impaired mucociliary clearance in patients with recalcitrant maxillary sinusitis. LEVEL OF EVIDENCE 3 Laryngoscope, 134:2646-2652, 2024.
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Affiliation(s)
- Vidit Talati
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Ali M Baird
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Mary Allen-Proctor
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Peter Papagiannopoulos
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Pete S Batra
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Peter Filip
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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Simpson T, Talati V, Baird AM, Gattuso P, Allen-Proctor MK, Papagiannopoulos P, Batra PS, Filip P, Tajudeen BA. Histopathology of Allergic Fungal Rhinosinusitis Versus Chronic Rhinosinusitis with Nasal Polyps. Laryngoscope 2024; 134:2617-2621. [PMID: 38073117 DOI: 10.1002/lary.31225] [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: 09/21/2023] [Revised: 11/13/2023] [Accepted: 11/27/2023] [Indexed: 05/09/2024]
Abstract
OBJECTIVE Structured histopathology (SHP) is a method of analyzing sinonasal tissue to characterize endotypes of chronic rhinosinusitis with nasal polyps (CRSwNP). Allergic fungal rhinosinusitis (AFRS) shares several features with certain endotypes of CRSwNP. Our objective was to compare the histopathology of AFRS and eosinophilic CRSwNP to further understand whether they are separate endotypes or disease entities altogether. METHODS A retrospective review of AFRS and CRSwNP patients undergoing endoscopic sinus surgery was performed. Data were collected on demographics, comorbidities, subjective and objective severity scores, and 13-variable SHP reports. CRSwNP patients with >10 eosinophils per high-power field (eCRSwNP) were included. Chi-squared and t-tests were used for statistical analysis. RESULTS A total of 29 AFRS and 108 eCRSwNP patients were identified. AFRS patients were younger and more often Black. Symptom severity scores (SNOT-22, Lund-MacKay, and Lund-Kennedy) were uniform between groups. AFRS patients had a higher rate of Charcot-Leyden crystals (41.4% vs. 10.2%; p < 0.001). Severe degree of inflammation, eosinophilic inflammatory predominance, eosinophil aggregates, subepithelial edema, and basement membrane thickening were common in both groups, and their rates were not statistically significantly different between groups. Metaplasia, ulceration, fibrosis, and hyperplastic/papillary change rates were low (<30%) and similar between groups. CONCLUSION The SHP of eCRSwNP and AFRS are highly consistent, which suggests AFRS is a severe subtype of CRSwNP overall rather than a separate disease entity. This also lends credence to AFRS belonging on the endotypic spectrum of CRSwNP. LEVEL OF EVIDENCE 3 Laryngoscope, 134:2617-2621, 2024.
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Affiliation(s)
- Tamara Simpson
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Vidit Talati
- Department of Otorhinolaryngology-Head and Neck Surgery and Rush Sinus, Allergy, and Asthma Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Ali M Baird
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Mary K Allen-Proctor
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Peter Papagiannopoulos
- Department of Otorhinolaryngology-Head and Neck Surgery and Rush Sinus, Allergy, and Asthma Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Pete S Batra
- Department of Otorhinolaryngology-Head and Neck Surgery and Rush Sinus, Allergy, and Asthma Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Peter Filip
- Department of Otorhinolaryngology-Head and Neck Surgery and Rush Sinus, Allergy, and Asthma Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery and Rush Sinus, Allergy, and Asthma Center, Rush University Medical Center, Chicago, Illinois, U.S.A
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Brar T, McCabe C, Miglani A, Marino M, Lal D. Tissue Eosinophilia is Superior to an Analysis by Polyp Status for the Chronic Rhinosinusitis Transcriptome: An RNA Study. Laryngoscope 2023; 133:2480-2489. [PMID: 36594502 DOI: 10.1002/lary.30544] [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: 09/01/2022] [Revised: 11/29/2022] [Accepted: 12/11/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE RNA sequencing (transcriptomics) is used to study biological pathways. However, the yield of data depends on comparing well-characterized cohorts. We compared tissue eosinophilia versus nasal polyp (NP) status as the metric to characterize transcriptomic mechanisms at play in eosinophilic and non-eosinophilic chronic rhinosinusitis (CRS) versus controls. METHODS RNA sequencing was conducted on sinonasal tissue samples of CRS and controls. Analyses were conducted based on polyp status [with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP)] as well as tissue eosinophil levels per high power field (eos/hpf)[non-eosinophilic (<10 eos/hpf, neCRS) or eosinophilic (≥10 eos/hpf, eCRS)]. The yield of differentially expressed genes (DEGs) and biological pathways through Ingenuity Pathway Analysis (IPA) were compared. RESULTS CRS tissue differed from controls by 736 statistically significant DEGs. Both NP status and tissue eosinophilia were effective in differentiating CRS from controls and into two distinct subgroups. Statistically significant DEGs identified when comparing CRS by NP status were 60, whereas 110 DEGs were identified using eosinophil cutoff ≥10 and <10 eos/hpf. Additionally, heatmaps showed greater homogeneity within each CRS subgroup when analyzed by tissue eosinophilia versus NP status. On IPA, the IL-17 signaling pathway was significantly different only by tissue eosinophilia status, not NP status, being higher in CRS <10 eos/hpf. CONCLUSION Tissue eosinophilia is superior to an analysis by NP status for the study of CRS transcriptome by RNA sequencing in identifying DEGs. Classification of CRS samples by eosinophil counts agnostic of NP status may offer advantageous insights into CRS pathogenetic mechanisms. LEVEL OF EVIDENCE 3 Laryngoscope, 133:2480-2489, 2023.
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Affiliation(s)
- Tripti Brar
- Division of Rhinology, Department of Otolaryngology, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| | - Chantal McCabe
- Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, Arizona, USA
| | - Amar Miglani
- Division of Rhinology, Department of Otolaryngology, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| | - Michael Marino
- Division of Rhinology, Department of Otolaryngology, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| | - Devyani Lal
- Division of Rhinology, Department of Otolaryngology, Mayo Clinic in Arizona, Phoenix, Arizona, USA
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Brown HJ, Tajudeen BA, Kuhar HN, Gattuso P, Batra PS, Mahdavinia M. Defining the Allergic Endotype of Chronic Rhinosinusitis by Structured Histopathology and Clinical Variables. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2021; 9:3797-3804. [PMID: 34174492 PMCID: PMC8511331 DOI: 10.1016/j.jaip.2021.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 05/20/2021] [Accepted: 06/03/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Atopy has a strong association with chronic rhinosinusitis (CRS). OBJECTIVE To understand whether patients with atopy and CRS can be defined by markers of tissue histopathology, systemic biomarkers, and clinical factors, which may guide their response to new pharmacologic agents. METHODS In a retrospective cohort of CRS patients who underwent functional endoscopic sinus surgery, a structured histopathology report consisting of 12 variables, comorbid conditions, preoperative total serum IgE levels, and preoperative modified Lund-Kennedy endoscopic and sinonasal outcome test (SNOT-22) scores were compared between atopic CRS (aCRS) and non-aCRS control patients in a multivariable model. RESULTS A total of 380 CRS patients were enrolled, 286 of whom had comorbid atopy (aCRS). Compared with non-aCRS, aCRS patients had significantly higher preoperative total SNOT-22 scores (40.45 ± 22.68 vs 29.70 ± 20.68, P = .015) and symptom-specific SNOT-22 scores in all domains except psychological dysfunction. Relative to non-aCRS, aCRS patients had increased tissue eosinophilia (P < .0001), eosinophil aggregates (P < .0001), Charcot-Leyden crystals (P < .04), fibrosis (P < .02), total serum IgE levels (P < .04), polyploid disease (P < .001), and a prevalence of comorbid asthma (P < .0001) and aspirin exacerbated respiratory disease (AERD) (P < .003). Patients with aCRS demonstrated increased tissue eosinophilia compared with non-aCRS patients even after controlling for polypoid disease, asthma, and AERD. CONCLUSION In the context of CRS, atopy appears to be a specific predictor of CRS severity linked to specific histopathologic variables, including enhanced eosinophilic aggregates. Moving forward, allergic status may be a useful way to identify an atopic endotype of CRS patients. Furthermore, after surgery, patients are often maintained on intranasal corticosteroids. In patients whose disease is unresponsive to steroids, we may look to atopic status to identify another management therapy. Atopic CRS patients, irrespective of polyp and asthmatic status, could be optimal candidates for biologic agents such as T-helper cell, eosinophil, and/or IgE-targeted therapies.
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Affiliation(s)
- Hannah J Brown
- Rush Medical College, Rush University Medical Center, Chicago, Ill
| | - Bobby A Tajudeen
- Rush Sinus Program, Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, Ill
| | - Hannah N Kuhar
- Department of Otolaryngology - Head and Neck Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, Ill
| | - Pete S Batra
- Rush Sinus Program, Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, Ill
| | - Mahboobeh Mahdavinia
- Section of Allergy/Immunology, Department of Internal Medicine, Rush University Medical Center, Chicago, Ill.
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Ganti A, Brown HJ, Gattuso P, Ghai R, Papagiannopoulos P, Batra PS, Tajudeen BA. Inter-pathologist Agreement on Structured Histopathology Reporting in Chronic Rhinosinusitis. Ann Otol Rhinol Laryngol 2021; 130:899-903. [PMID: 33412911 DOI: 10.1177/0003489420987970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Structured histopathology reporting is increasingly being utilized in rhinology to characterize endotypes in chronic rhinosinusitis and guide management decisions after sinus surgery. OBJECTIVE The goal of this investigation is to evaluate inter-observer agreement in structured histopathology reporting. METHODS Two experienced head and neck pathologists independently compiled structured histopathology reports for tissue samples collected during functional endoscopic sinus surgery. Cohen's standard kappa (κ) coefficients were calculated for each histopathologic variable to assess inter-pathologist agreement. RESULTS A total of 92 cases were analyzed. Substantial inter-pathologist agreement was reached on tissue eosinophil count (κ = 0.64, P < .001), the presence of eosinophil aggregates (κ = 0.62, P < .001), and the presence of fungal elements (κ = 0.74, P < .001). There was moderate agreement on the degree of inflammation (κ = 0.56, P < .001) and the presence of squamous metaplasia (κ = 0.46, P < .001). There was fair agreement on the presence of neutrophil infiltrates (κ = 0.33, P < .001), the presence of hyperplastic changes (κ = 0.40, P < .001), and the presence of fibrosis (κ = 0.24, P = .022). There was only slight agreement on the degree of subepithelial edema (κ = 0.20, P = .008). The κ coefficients for basement membrane thickening and mucosal ulceration were not statistically significant. CONCLUSION High inter-pathologist agreement was demonstrated for several salient histopathologic variables, including tissue eosinophil count and the presence of eosinophil aggregates. However, refining the definitions of certain histopathologic variables may improve the reproducibility of structured histopathology reporting.
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Affiliation(s)
- Ashwin Ganti
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Hannah J Brown
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - Ritu Ghai
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - Peter Papagiannopoulos
- Rush Sinus Program, Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Pete S Batra
- Rush Sinus Program, Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Bobby A Tajudeen
- Rush Sinus Program, Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA
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Brescia G, Alessandrini L, Marioni G. Structured histopathology for endotyping and planning rational treatment in chronic rhinosinusitis. Am J Otolaryngol 2021; 42:102795. [PMID: 33128996 DOI: 10.1016/j.amjoto.2020.102795] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 02/08/2023]
Abstract
In chronic rhinosinusitis (CRS), endotyping, being based on the pathogenic mechanism, provides a precise picture appropriate for use in clinical practice. Structured histopathological examination of CRS is considered a necessary step in efforts to establish its pathogenesis and improve our endotyping capabilities. Herein we discuss the associations between histopathology and clinical characteristics of CRS patients to assist medical and surgical treatment choices.
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