Inverted papilloma of the nasal cavity and paranasal sinuses: A Korean multicenter study

Abstract

Generally, there were no significant differences in recurrence rates according to clinical stage or surgical approach. Given the rate of delayed recurrence, follow-up of >3 years is required. Moreover, surgeons should always consider combined approaches to reduce the chances of recurrence.

Advances in recurrence and malignant transformation of sinonasal inverted papillomas

“…An association between Krouse stage system and recurrence of SIP was not identified in a recent study involving 156 SIP patients (19). In a multicenter study involving 578 SIP patients, three stage systems (the Krouse staging system, the Furuta staging system and the Cannady staging system) did not associate with SIP recurrence rates (2). This study also suggested that patients with advanced stage of SIP who underwent single endoscopic surgery presented a higher recurrence rate.…”

“…A study of 212 SIP patients demonstrated that SIP lesions with an extensive involvement of the frontal sinus and/or supraorbital cell may require a combined approach (25). In addition, the Korean multicenter study suggested that surgeons should consider combined approaches to reduce recurrence for advanced SIP [Krouse staging system: T3 stage (12); Furuta staging system: T3-A stage (13); Cannady staging system: group B (14)], particularly for novice surgeons (2). Although certain authors propose that SIP involving attachment sites within the maxillary sinus require a endoscopic-external combined technique (1,26), emerging evidence suggests that novel tailored ESS techniques (endoscopic modified medial maxillectomy, and transnasal endoscopic anterior and medial maxillectomy) allow enhanced visualization and preserve important structures, including the inferior turbinate and nasolacrimal duct (27)(28)(29).…”

“…Currently, there are no distinct clinical signs and symptoms that differentiate SIP and malignant transformation of SIP (2,32). The diagnosis of SIP malignant transformation is based on the observation of synchronous transformation, which appears at the same time as papilloma, and metachronous transformation, which appears at the site of a previous papilloma (41).…”

“…Pathologically, SIP epithelium inverts into submucosal stroma, which is distinguished from other types of nasal papilloma. Unlike other benign tumors, SIP exhibits remarkable aggressive behaviors, including invasiveness, recurrence and malignant transformation (~10%) (2). Therefore, SIP can spread into the sparanasal sinus, orbit, and cranial base, which can lead to poor prognosis for SIP patients (2).…”

“…Currently, the majority of surgeons prefer endoscopic methods to traditional external approaches, due to similar success rates, less trauma and no facial scars. However, the common view is that SIP recurrence is due to inadequate removal during the first surgery (2)(3)(4). Therefore, preoperative evaluation as well as postoperative follow up is very important.…”