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Rationale of New Grading System: Central Compartment Atopic Disease.

Ramón Moreno-Luna1,2, Carmen Palma-Martínez1, Serafin Sánchez-Gómez1,2

  • 1Department of Otorhinolaryngology, Virgen Macarena University Hospital, University of Seville, Sevilla, Spain.

International Forum of Allergy & Rhinology
|February 6, 2026
PubMed
Summary
This summary is machine-generated.

Nasal endoscopy is confirmed as the primary diagnostic tool for central compartment atopic disease (CCAD), a specific type of chronic rhinosinusitis. This study established a reliable classification system with high expert agreement for CCAD diagnosis.

Keywords:
Delphi methodnasal polypsrhinosinusitistype 2 inflammation

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Area of Science:

  • Otolaryngology
  • Allergy and Immunology
  • Medical Diagnostics

Background:

  • Central compartment atopic disease (CCAD) is a recently identified phenotype of type 2-dominant chronic rhinosinusitis (CRS).
  • Current international guidelines lack standardized diagnostic and classification criteria for CCAD, despite recognizing polypoid changes.
  • There is a need for a consensus-based classification system to aid in the diagnosis and study of CCAD.

Purpose of the Study:

  • To develop and internally validate a consensus-based classification system for CCAD.
  • To establish clear diagnostic and grading criteria for CCAD through expert agreement.
  • To determine the optimal diagnostic modalities for CCAD.

Main Methods:

  • A two-round modified Delphi study involving 10 international rhinology experts.
  • Evaluation of diagnostic value of nasal endoscopy versus radiology.
  • Assessment of a proposed grading system (Grades 0-IV) using endoscopic and radiologic cases.
  • Predefined consensus threshold of ≥80% agreement on a 5-point Likert scale.

Main Results:

  • Nasal endoscopy was identified as the primary diagnostic tool by 80% of experts.
  • High interpretive accuracy and substantial interobserver agreement (κ=0.72) were observed for the preliminary grading system.
  • Refined definitions in the second round improved consensus and reproducibility, reaching κ=0.80, with radiology playing a complementary role.

Conclusions:

  • Nasal endoscopy is the key diagnostic method for CCAD, demonstrating substantial interobserver reproducibility.
  • The refined classification system enhances diagnostic clarity and agreement for CCAD.
  • This framework aids in differentiating CCAD from other CRS phenotypes and supports future research.