Clinical Implication of Diagnostic and Histopathologic Discrepancies in Sinonasal Malignancies

Abstract

Objectives To evaluate the incidence of histopathologic diagnostic discrepancy for patients referred to our institution, identify pathologies susceptible to diagnostic error, and assess the impact on survival of histopathologic diagnostic discrepancies. Methods Three hundred ninety‐seven patients with sinonasal cancers were identified, and discordance between the outside pathologic report and MD Anderson Cancer Center pathologic report was assessed. Overall survival and disease‐specific survival were analyzed using Kaplan–Meier and log rank methods. Results Discordance of major histopathologic diagnoses was present in 24% (97 of 397) of reports, with sinonasal undifferentiated carcinoma, sarcoma, neuroendocrine carcinoma, and poorly differentiated carcinoma pathologies having the highest change in diagnosis (P < .01). A further 61% (244 of 397) had minor changes such as histologic grade, subtype, or stage, with sarcoma and neuroendocrine carcinoma pathologies being most susceptible to change (P < .02). Overall, the 5‐year overall survival (OS) and disease‐specific survival (DSS) was reduced in patients with a major change in histopathologic diagnosis (59.2% vs. 70.2% (P = .02) and 72.9% vs. 81.2% (P = .02), respectively). Furthermore, patients with a major change in diagnosis and prior treatment experienced a significant reduction in 5‐year OS (61.9% vs. 70.4%, P = .03 < .01) and DSS (72.4% vs. 81.5%, P = .04). Conclusion Histopathological diagnosis of sinonasal tumors is complex and challenging given the rarity of the disease. Obtaining the correct diagnosis is important for treatment selection and survival. In histologies prone to misdiagnoses, obtaining a second opinion from experienced head and neck pathologists at a high‐volume institution may potentially lead to a change in treatment recommendations that could result in improved survival in patients with sinonasal malignancies. Level of Evidence 4 Laryngoscope, 131:E1468–E1475, 2021

Long‐Term Outcomes of Olfactory Neuroblastoma: MD Anderson Cancer Center Experience and Review of the Literature

“…In contrast, ONB is associated with excellent outcomes with only locoregional treatment. 9,10 Traditionally ONB was treated surgically with anterior craniofacial resection that entails bi-frontal craniotomy in combination with transfacial lateral rhinotomy. 11 However, in recent decades, endoscopic resection became more frequently used as surgical approach for ONB.…”

“…Other non‐ONB neuroendocrine tumors have a high rate of systemic failure and require incorporation of systemic treatment. In contrast, ONB is associated with excellent outcomes with only locoregional treatment 9,10 …”

Expect the unexpected – sinonasal papillary intestinal adenocarcinoma – A case report

“…In fact, the rarity of sinonasal tumors and the wide range of histology's explain the high rate of diagnostic discrepancies detected after pathologic revision by expert pathologists. [7] Further on, even if the radiological findings were deceptive in our case reported as chronic granulomatous disease, the decision of the surgeon for the excision biopsy played a major aspect in the treatment of the patient.…”

Sinonasal diffuse large B-cell lymphoma in a patient with Wiskott–Aldrich syndrome: A case report and literature review

“…The sinonasal malignancies initially cause very few symptoms. Moreover, due to the infrequently involved location, tumors in this area are often misdiagnosed as sinusitis at the early stage ( 20 ). As a result, such as the case we reported, a high index of suspicion of sinus malignancy in WAS patients with a history of chronic sinusitis in combination with cranial neuralgia or orbital symptoms and signs should be considered.…”