Clinical assessment, diagnosis and management of patients with unilateral sinonasal disease

Gomes, Patrícia; Gomes, Alexandra; Salvador, Pedro; Lombo, Catarina; Caselhos, Sérgio; Fonseca, Rui

doi:10.1016/j.otorri.2018.11.002

Cited by 8 publications

(8 citation statements)

References 27 publications

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“…In differentiating benign from malignant neoplasia, overlap exists at MRI in terms of enhancement pattern and diffusion characteristics [ 32 ]. Nonetheless, both require ESS for definitive treatment or biopsy confirmation, respectively [ 33 ]. Where malignancy is confirmed, the diagnostic confidence demonstrated by our results confirms the superiority of MRI over CT in delineating perineural and skull base invasion [ 14 ] or overall resection/radiotherapy margins ( Figure 6 ).…”

Section: Discussionmentioning

confidence: 99%

“…Case series of unilateral sinonasal opacification have also presented CT findings in isolation and recommended proceeding to further investigation with biopsy [ 13 , 37 ]. MRI was only utilised in a small subset of cases if neurological deficits or complications of infection were suspected [ 33 ]; thus, evaluation of its PPV for neoplastic disease was not possible.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of MRI and CT in the Evaluation of Unilateral Maxillary Sinus Opacification

Chua

Navaratnam

Leger

et al. 2021

Radiology Research and Practice

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Objectives. To evaluate the diagnostic performance of MRI compared with CT in differentiating neoplastic from infectious/inflammatory causes of complete unilateral maxillary sinus opacification (UMSO). Although MRI is increasingly used, no studies validate its utility compared to CT or nasal endoscopy in this context. Methods. A retrospective analysis of 49 patients presenting with complete UMSO to a tertiary referral centre was performed, investigated with both CT and MRI. Two head and neck radiologists independently reviewed each imaging modality and recorded both a final diagnosis and Likert-scale diagnostic certainty score. A consensus radiological diagnosis was determined, stratified into potentially neoplastic or infectious/inflammatory aetiology, and compared with nasal endoscopy and final diagnosis. Diagnostic performance and interoperator agreement for predicting neoplasia were calculated. Results. Both CT and MRI demonstrated high sensitivity and negative predictive value for neoplasm, although MRI was more specific (79%; 95% CI: 60–92%) than CT (14%; 95% CI: 4–32%), with a higher positive predictive value. MRI was more accurate (88%; 95% CI: 75–95%) than CT (49%; 95% CI: 34–64%) in diagnosing neoplasia. MRI had significantly higher diagnostic certainty Likert scores than CT ( p < 0.0001 for both observers). Interobserver agreement was fair for CT (kappa coefficient = 0.327) and excellent for MRI (kappa coefficient = 0.918). Conclusions. MRI is more specific than CT in characterising UMSO, with greater diagnostic certainty and reproducibility. The additive diagnostic value of MRI complements CT, potentially reducing diagnostic delays in some cases and the need for diagnostic endoscopic sinus surgery in others. We recommend MRI incorporation into the diagnostic pathway for patients with UMSO.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of MRI and CT in the Evaluation of Unilateral Maxillary Sinus Opacification

Chua

Navaratnam

Leger

et al. 2021

Radiology Research and Practice

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“…Surgical pathology was consistent with in‐office biopsies in 86.8% of cases, with three of the inconsistent cases being upgraded from benign inflammation to a benign or malignant lesion. No complications were reported 155 . Gomes et al.…”

Section: Biopsymentioning

confidence: 95%

“…There is a moderate risk of a false‐negative diagnosis. One potential explanation for the false‐negative results may relate to the tendency of sinonasal lesions to develop overlying polypoid edema, which may mask the underlying lesion 155 . A high degree of clinical suspicion may help clinicians identify cases of inaccurate diagnosis and prompt a surgical biopsy.…”

Section: Biopsymentioning

confidence: 99%

“…Lesions should be easily visualized with a nasal speculum or endoscope within the nasal cavity, or accessible sinuses 153,154 . Lesions that are suspected to be vascular or in continuity with the intracranial space (i.e., encephaloceles) are considered to be contraindicated for in‐office biopsies 153,155 . Unilateral vascular sinonasal lesions in adolescent and young adult males should be treated with particular caution, given the specific risk of JNA, which would be contraindicated due to risk of severe hemorrhage.…”

Section: Biopsymentioning

confidence: 99%

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International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors

Kuan

Wang

Adappa

et al. 2024

Int Forum Allergy Rhinol

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BackgroundSinonasal neoplasms, whether benign and malignant, pose a significant challenge to clinicians and represents a model area for multidisciplinary collaboration in order to optimize patient care. The International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors (ICSNT) aims to summarize the best available evidence and presents 48 thematic and histopathology‐based topics spanning the field.MethodsIn accordance with prior ICAR documents, ICSNT assigned each topic as an Evidence‐Based Review with Recommendations, Evidence‐Based Review, and Literature Review based on level of evidence. An international group of multidisciplinary author teams were assembled for the topic reviews using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses format, and completed sections underwent a thorough and iterative consensus‐building process. The final document underwent rigorous synthesis and review prior to publication.ResultsThe ICNST document consists of 4 major sections: general principles, benign neoplasms and lesions, malignant neoplasms, and quality of life and surveillance. It covers 48 conceptual and/or histopathology‐based topics relevant to sinonasal neoplasms and masses. Topics with a high level of evidence provided specific recommendations, while other areas summarized the current state of evidence. A final section highlights research opportunities and future directions, contributing to advancing knowledge and community intervention.ConclusionAs an embodiment of the multidisciplinary and collaborative model of care in sinonasal neoplasms and masses, ICSNT was designed as a comprehensive, international, and multidisciplinary collaborative endeavor. Its primary objective is to summarize the existing evidence in the field of sinonasal neoplasms and masses.This article is protected by copyright. All rights reserved

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The diagnostic value of image-enhanced endoscopy system in sinonasal inverted papilloma

Ren,

Fang,

Wang

et al. 2024

Eur Arch Otorhinolaryngol

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Clinical assessment, diagnosis and management of patients with unilateral sinonasal disease

Cited by 8 publications

References 27 publications

Comparison of MRI and CT in the Evaluation of Unilateral Maxillary Sinus Opacification

Comparison of MRI and CT in the Evaluation of Unilateral Maxillary Sinus Opacification

International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors

The diagnostic value of image-enhanced endoscopy system in sinonasal inverted papilloma

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