Origin site‐based staging system of sinonasal inverted papilloma for application to endoscopic sinus surgery

Background A staging system is essential for determining the optimal surgical approach and predicting postoperative outcomes for inverted papilloma (IP). Although staging systems based on the extent to which the location is occupied by an IP have been widely used, an origin site-based classification of IP using unsupervised machine learning algorithms has recently been reported. Objective To determine the most appropriate of five staging systems for sinonasal IP by comparing recurrence rates for each stage according to each of those systems. Methods Eighty-seven patients with sinonasal IP were enrolled in the study. Their tumors were retrospectively categorized according to the Krouse, Oikawa, Cannady, and Han staging systems, which are based on the extent of IP, and the Meng system, which is based on the site of origin. The rates of recurrence for each stage of the five systems were compared. Results Seven of the 87 patients (8.0%) had recurrences during an average 45.5 months (12–138 months) of follow-up. There were significant differences in disease-free survival between the stages specified by Han and Meng (p = 0.027 and p < 0.001, respectively), but not between the stages specified by Krouse, Oikawa, and Cannady (p = 0.236, 0.062, and 0.130, respectively). Cox proportional hazard models revealed that Meng system (adjusted hazard ratio [aHR] 4.32, 95% confidence interval [CI] 1.10–17.04) and presence of dysplasia (aHR 7.42, 95% CI 1.15–47.85) were significantly associated with recurrence. Conclusion The staging systems proposed by Han and Meng were found to be accurate in terms of tumor recurrence. We recommend use of the Han staging system before surgery and the Meng system after intraoperative identification of the origin of the tumor.

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A case report of inverted papilloma associated with esthesioneuroblastoma treated by endoscopic sinus surgery

American Journal of Otolaryngology ◽

10.1016/s0196-0709(03)00003-6 ◽

2003 ◽

Vol 24 (3) ◽

pp. 181-182 ◽

Cited By ~ 5

Author(s):

Ernesto Pasquini ◽

Vittorio Sciarretta ◽

Giacomo Ceroni Compadretti ◽

Cosetta Cantaroni

Keyword(s):

Case Report ◽

Endoscopic Sinus Surgery ◽

Inverted Papilloma ◽

Sinus Surgery

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S278 – Management Strategies for Sinonasal Inverted Papilloma

Otolaryngology ◽

10.1016/j.otohns.2008.05.454 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P168-P168

Author(s):

Michael Hoa ◽

Gruber Bianca ◽

John H Krouse

Keyword(s):

Intraoperative Complications ◽

Management Strategies ◽

Preoperative Staging ◽

Retrospective Chart Review ◽

Inverted Papilloma ◽

Sinus Surgery ◽

Disease Stage ◽

Secondary Outcome ◽

Recurrence Rates ◽

Sinonasal Inverted Papilloma

Objectives 1) To compare endoscopic and external approaches in the management of sinonasal inverted papilloma at our institution. 2) To discuss the relationship of these management strategies to disease stage and malignancy. Methods Retrospective chart review of 18 patients who had operations performed to remove sinonasal inverted papilloma. Demographic, imaging and intraoperative data were collected from clinic charts. All patients had a definitive procedure performed between 2001 and 2007, with preoperative staging by CT, MRI or both. The primary outcome measure was recurrence and secondary outcome measures included association with malignancy and intraoperative complications. Results CT and MRI scanning were utilized for staging in 88% and 53% of cases, respectively. Mean follow-up was 16.3 months. All T1 lesions were managed by functional endoscopic sinus surgery (FESS). 71% of T3 lesions were managed by transnasal endoscopic medial maxillectomy (TEMM). 33% and 67% of large T3 and T4 lesions were managed with external procedures and TEMM, respectively. Recurrence rates for T1, T3, and T4 lesions were 0%, 16.7%, and 100%, respectively. Recurrence by surgical method were 0%, 18% (1 T3 and 1 T4), and 0% for FESS, TEMM and external approaches, respectively. Conclusions Inverted papilloma tended to present at more advanced stage. T1 and T3 lesions were generally managed by FESS and TEMM, respectively. Large T3 and T4 lesions were generally managed via external approaches or required further definitive management via an external approach. MRI, especially with frontal disease, may augment CT scanning, identifying true tumor mass, and thus provide indications for or against supplementary procedures.

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Preoperative Staging and Surgical Approaches for Sinonasal Inverted Papilloma

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348940711600909 ◽

2007 ◽

Vol 116 (9) ◽

pp. 674-680 ◽

Cited By ~ 24

Author(s):

Keita Oikawa ◽

Yasushi Furuta ◽

Yuji Nakamaru ◽

Nobuhiko Oridate ◽

Satoshi Fukuda

Keyword(s):

Preoperative Staging ◽

Staging System ◽

Endoscopic Approach ◽

Sinus Surgery ◽

Surgical Approaches ◽

External Approach ◽

Sinonasal Inverted Papilloma ◽

Mri Staging ◽

First Choice ◽

Magnetic Resonance Imaging Mri

Objectives: We sought to determine the value of preoperative staging by magnetic resonance imaging (MRI) assessment in the surgical management of sinonasal inverted papillomas (IPs). Methods: Preoperative MRI staging was used to assess 22 patients with IPs. In addition to the Krouse staging system, T3 cases were categorized as subgroup T3-B if tumors extended into the frontal sinus or the supraorbital recess; otherwise, they were categorized as T3-A. Standard endoscopic sinus surgery (ESS) was the first choice for T1 and T2 cases. Endoscopic approaches, including ESS combined with endoscope-assisted transantral approach and endoscopic medial maxillectomy, were considered in T3-A cases, and external approaches were considered in T3-B cases. Patients were followed for a minimum of 1 year after surgery. Results: Preoperative MRI staging and postoperative staging were coincident in 21 of the 22 patients (95%). All 8 T2 cases were treated by an endoscopic approach. Of 10 T3-A cases, 9 (90%) were treated by an endoscopic approach and 1 (residual case) was treated by an external approach. All 3 of the T3-B cases underwent an external approach. One T4 case with malignant transformation underwent an external approach followed by radiotherapy. After a median follow-up period of 22 months, none of the 22 patients had had a recurrence. No major complications were observed after endoscopic approaches, but epiphora or hemorrhage requiring transfusion occurred in 3 of the 5 patients (60%) who underwent external approaches. Conclusions: Preoperative staging of IP by MRI is useful for selecting cases that can be managed by endoscopic approaches, resulting in lower rates of tumor recurrence and morbidity.

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Two Cases of Inverted Papilloma of the Sphenoid Sinus Resected with Endoscopic Sinus Surgery

Nihon Bika Gakkai Kaishi (Japanese Journal of Rhinology) ◽

10.7248/jjrhi.58.54 ◽

2019 ◽

Vol 58 (1) ◽

pp. 54-63

Author(s):

Hiromasa Takakura ◽

Hirohiko Tachino ◽

Hideo Shojaku

Keyword(s):

Endoscopic Sinus Surgery ◽

Sphenoid Sinus ◽

Inverted Papilloma ◽

Sinus Surgery

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Expression of Bone Morphogenic Protein in Sinonasal Inverted Papilloma with New Bone Formation

Allergy & Rhinology ◽

10.2500/ar.2011.2.0004 ◽

2011 ◽

Vol 2 (1) ◽

pp. ar.2011.2.0004 ◽

Cited By ~ 4

Author(s):

Tomoyo Okamoto ◽

Satoru Kodama ◽

Nozomi Nomi ◽

Shingo Umemoto ◽

Masashi Suzuki

Keyword(s):

Bone Formation ◽

Complete Removal ◽

Bone Morphogenic Protein ◽

Inverted Papilloma ◽

Sinus Surgery ◽

New Bone Formation ◽

Common Benign Tumor ◽

Sinonasal Inverted Papilloma ◽

Tumor Tissues

Inverted papilloma (IP) is a common benign tumor in the nose and sinus. Osteogenesis in sinonasal IP is extremely rare; to date, only five cases of IP with new bone formation appear in the literature. In addition, the mechanism of osteogenesis in IP remains unclear. Here, we describe three cases of IP with new bone formation and an investigation into a possible role for bone morphogenic protein (BMP) in osteogenesis. Of three patients with sinonasal IP with new bone formation, two were treated by endoscopic sinus surgery and one was followed up with watchful waiting. Tumor tissues were subjected to immunohistochemistry to detect BMP expression. The patients were successfully treated surgically and showed no evidence of recurrence postoperatively. Follow-up examination is ongoing. Immunohistochemically, the tumors expressed BMP-4 but not BMP-2 or BMP-7. ESS could be successfully used to achieve complete removal of the sinonasal IPs with new bone formation. BMP-4 might be associated with new bone formation in the tumor.

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