Is planned surgery important in sinonasal inverted papilloma?

Area of Science:

• Otolaryngology
• Pathology
• Medical Imaging

Background:

• Inverted papilloma (IP) is a benign sinonasal tumor with a potential for recurrence and malignant transformation.
• Clinical presentation of IP can be non-specific, leading to diagnostic challenges and delays.

Purpose of the Study:

• To identify clinical features associated with inverted papilloma misdiagnosis.
• To determine the impact of diagnostic timing (pre-operative, intra-operative, post-operative) on IP recurrence rates.

Main Methods:

• Retrospective analysis of 51 patients treated for inverted papilloma.
• Categorization of patients into three groups based on the timing of IP confirmation: post-operative, intra-operative, and pre-operative.
• Follow-up for at least one year to assess recurrence rates.

Main Results:

• The recurrence rates were 33% for post-operative diagnosis, 11% for intra-operative diagnosis, and 5% for pre-operative diagnosis.
• Bilateral sinonasal disease and specific CT findings (bony erosion, remodeling, sinus orifice widening) were associated with misdiagnosis.
• A significant difference in recurrence rates was observed based on diagnostic timing.

Conclusions:

• Early and accurate diagnosis of inverted papilloma is crucial for reducing recurrence.
• Clinicians should be aware of subtle signs and symptoms that may indicate IP, particularly in cases of bilateral sinonasal disease.
• Improved pre-operative diagnostic accuracy, potentially aided by frozen section analysis, can significantly improve patient outcomes.