Achieving the best method to classify Eosinophilic Chronic Rhinosinusitis: a systematic review

Area of Science:

• Otorhinolaryngology
• Pathology
• Immunology

Background:

• Chronic rhinosinusitis (CRS) classification relies on eosinophil counts in nasal biopsies.
• Current histopathologic criteria and cutoff points for eosinophilic CRS (eCRS) lack consensus.
• Variability exists in methodologies for quantifying eosinophils per high power field.

Purpose of the Study:

• To systematically review studies reporting cutoff points for eCRS classification.
• To extract data on the methodologies used for eCRS classification.
• To identify the need for standardization in eCRS diagnosis.

Main Methods:

• A systematic electronic search was conducted across major biomedical databases (BVS, PubMed, Scopus, etc.).
• Studies reporting a cutoff point for eCRS classification were included.
• Data on classification methodology and reported cutoff values were extracted.

Main Results:

• 142 studies were identified, reporting 29 different cutoff values for eCRS.
• 13 studies detailed their specific methodologies for establishing cutoff points.
• Diverse reference standards were used, including asthma, allergy, and quality of life indices.

Conclusions:

• Further research, including international multicentered cluster analysis, is needed for a precise eCRS cutoff.
• Methodological standardization of biopsy and analysis is essential for comparable results.
• Recommendations include multiple biopsy sites, examination of densest infiltration areas, and pre-biopsy oral steroid restriction.