Treatment outcomes and predictors for systemic steroids in nasal polyposis

Won, Tae Bin; Jang, Eunseok; Min, Soo Kee; Kim, Si Whan

doi:10.3109/00016489.2012.659753

Cited by 11 publications

(10 citation statements)

References 16 publications

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“…From the facts, tissue eosinophils may be less affected by glucocorticoid than peripheral eosinophils, especially in ECRS. Previous reports used a longer time (20 mg/day for 14 days) or a higher dose (1 mg/kg/day for 7 days) of oPSL for CRSwNP [20, 21]. Although the differences for tissue eosinophil reaction demonstrated in the present study might be dose or time dependent, at least low-dose and short-term oPSL, as presented in this study for ECRS patients, did not markedly affect the entire tissue eosinophil count.…”

Section: Discussioncontrasting

confidence: 46%

“…Therefore, tissue eosinophil infiltration appears to be suppressed after corticosteroid treatments; however, the clinical changes induced in tissue eosinophil counts by oPSL have not yet been clarified, particularly in ECRS. Won et al [20] reported that the eosinophil infiltration ratio in polyps decreased from 14 to 9% after 20 mg/day PSL for 14 days. Kroflic et al [21] revealed that many CRSwNP patients (75%) showed decreases in tissue eosinophil counts from 1/2 to 1/8, and the mean count significantly decreased from 502/10 HPF to 190/10 HPF after a 7-day treatment with 1 mg/kg/day PSL.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Preoperative Systemic Corticosteroids on the Histology and Diagnosis of Eosinophilic Chronic Rhinosinusitis

Akiyama

Makihara²,

Uraguchi³

et al. 2019

Int Arch Allergy Immunol

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Background: The histological changes corticosteroids induce in nasal polyps, and whether these changes have an impact on the diagnosis of eosinophilic chronic rhinosinusitis (ECRS), currently remain unclear. Objectives: A prospective controlled multicenter trial was conducted to evaluate the efficacy of the low-dose and short-term oral prednisolone (oPSL) treatment for tissue eosinophil infiltrations in ECRS. Methods: Subjects with ECRS diagnosed by previous biopsies received a low dose of oPSL for 3 days (PSL 3) or 7 days (PSL 7) before surgery. Changes in the tissue eosinophil count after these treatments were evaluated. Furthermore, the percent change of tissue eosinophil count from baseline and its impact on the diagnosis defined by the JESREC study were examined. Results: There were 23 and 21 subjects in the PSL 3 and PSL 7 groups, respectively. Polyp scores, clinical symptom scores, and the proportion of blood eosinophils significantly decreased after the treatment, and no significant differences were observed between the groups. The entire tissue eosinophil count tended to be slightly decreased in both groups without reaching a statistically significant value. The median percent change of tissue eosinophil count from baseline was 83.6%, and only the posttreatment proportion of blood eosinophil showed a mild correlation with it. Seven out of 44 nasal polyp specimens collected from the superficial part of the middle meatus showed < 70 eosinophils/high-power field; therefore, the false negative rate was 15.9%, but decreased to 11.4% when other parts were included in the histological evaluation. Conclusions: Low-dose and short-term oPSL did not appear to markedly affect the tissue eosinophil count in ECRS patients; however, the potential for misdiagnoses due to the effects of oPSL cannot be rejected. The diagnosis of ECRS prior to the administration of corticosteroids or tissue evaluations using multiple tissue parts is desirable.

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Section: Discussioncontrasting

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Impact of Preoperative Systemic Corticosteroids on the Histology and Diagnosis of Eosinophilic Chronic Rhinosinusitis

Akiyama

Makihara²,

Uraguchi³

et al. 2019

Int Arch Allergy Immunol

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“…Jankowski, et al 21 reported that eosinophil infiltration is a striking feature of nasal polyposis, and systemic steroids appear to be significantly more effective at reducing eosinophil infiltration than topical steroids in selected patients undergoing surgery. Won, et al 20 also reported that the eosinophil infiltration ratio in polyp tissues decreased after steroid administration. As previous studies have reported, eosinophil infiltration seems to be reduced by systemic steroid therapy.…”

Section: Discussionmentioning

confidence: 93%

“…Atopy was defined as a positive response to one or more allergens on SPT and/or MAST. 20 Eosinophilic infiltration was defined when eosinophils account for >20% of the total inflammatory cells. 21 The radiologic findings of paranasal sinus (PNS) CT were scored using the Lund-Mackay scoring system.…”

Section: Methodsmentioning

confidence: 99%

Availability of Preoperative Systemic Steroids on Endoscopic Sinus Surgery for Chronic Rhinosinusitis with Nasal Polyposis

Hong

Lee

et al. 2014

Yonsei Med J

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PurposeTo analyze the outcome of endoscopic sinus surgery (ESS) after preoperative systemic steroid (PSS) treatment for chronic rhinosinusitis (CRS) with nasal polyposis (NP) and to investigate and compare clinicopathological factors associated with the outcome.Materials and MethodsWe performed a retrospective chart review of 468 patients with CRS with NP who underwent primary ESS between January 2005 and October 2011. 124 patients who met the inclusion criteria were included. Beginning from 2008, our clinic administered steroid preoperatively in patients of CRS with NP, thus there were 84 patients with preoperative systemic steroid (PSS group) and another 40 patients without such regimen (no PSS group). To evaluate the outcome after ESS, poor outcome and complication were analyzed according to the following parameters: age, sex, follow-up duration, eosinophilic infiltration, atopy, asthma, Lund-Mackay score, and polyp grade.ResultsThere was no significant difference in poor outcome rates between the PSS and no PSS group (35.0% vs. 47.6%, p=0.185). There was no significant difference in complication rates between the PSS and no PSS group (10% vs. 6%, p=0.468). As with the multivariate analysis of the clincopathological factors to the poor outcome rate, presence of asthma and eosinophilic infiltration were significantly related (odds ratio as 6.555 and 4.505, respectively), whereas PSS was confirmed as less likely related (odds ratio 0.611).ConclusionLow dose PSS administration does not seem to have an effect on the outcome after ESS in patients who have CRS with NP. Eosinophilic infiltration and presence of asthma are important predictors of surgical outcome.

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“…Therefore, it is suggested the prevalence of ECRS is similar to that of asthma with the maximum prevalence at the early seventh decade (10). It was reported that daily administration with prednisolone at a dose of 15 mg for 10 days or 20 mg for 14 days reduced the number of eosinophils in the nasal polyps of patients with CRS with nasal polyps (9,11). Accordingly, there was a possibility that preoperative administration with steroid reduced the number of eosinophils in the nasal polyps, resulting in a false negative diagnosis of definite ECRS after ESS, because definite ECRS is diagnosed based on the microscopic findings of more than 70 eosinophils in high power magnification fields of the resected nasal polyps.…”

Section: Discussionmentioning

confidence: 99%

Short-term pre-operative systemic administration with low-dose of steroid does not make a false-negative diagnosis of definite eosinophilic chronic rhinosinusitis after endoscopic sinus surgery

et al. 2019

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According to JESREC criteria, definite eosinophilic chronic rhinosinusitis (ECRS) is postoperatively diagnosed based on over 70 eosinophils in high power magnification fields of the resected nasal polyps in patients with probable ECRS. Preoperative systemic administration with steroid is a standard practice, because it reduced intraoperative bleeding during endoscopic sinus surgery (ESS) in patients with ECRS. However, it was recently reported that systemic administration with steroid decreased the number of eosinophils in the nasal polyps, leading to a false negative diagnosis of definite ECRS. To overcome the risk, we have adopted shortterm pre-operative systemic administration with low-dose of steroid and examined if our steroid administration makes a false-negative diagnosis. We performed a retrospective chart review of 42 patients with probable ECRS. Eleven patients were administered with 0.5 mg of bethametasone for 7 days before ESS, and other 31 patients were not administered. The average number of eosinophils in nasal polyps in patients who were administered with steroid was 188 ± 167, which was not different from 199 ± 149 in the patients who were not administered. These findings suggest that short-term preoperative administration with low-dose of steroid has few risk of a false-negative diagnosis of definite ECRS.

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Treatment outcomes and predictors for systemic steroids in nasal polyposis

Cited by 11 publications

References 16 publications

Impact of Preoperative Systemic Corticosteroids on the Histology and Diagnosis of Eosinophilic Chronic Rhinosinusitis

Impact of Preoperative Systemic Corticosteroids on the Histology and Diagnosis of Eosinophilic Chronic Rhinosinusitis

Availability of Preoperative Systemic Steroids on Endoscopic Sinus Surgery for Chronic Rhinosinusitis with Nasal Polyposis

Short-term pre-operative systemic administration with low-dose of steroid does not make a false-negative diagnosis of definite eosinophilic chronic rhinosinusitis after endoscopic sinus surgery

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