Diagnostic accuracy and influencing factors of preoperative biopsies in sinonasal malignancy

The nasal cavity's cytological diversity necessitates pathological confirmation for treatment planning, especially in malignancies. However, the accuracy of preoperative biopsies and their influencing factors are still unclear. This study aimed to evaluate histopathologic concordance between preoperative biopsy and permanent pathology by technique and identify factors contributing to misdiagnosis.

We identified 652 patients diagnosed with sinonasal solid malignancy between 1991 and 2023. Excluding those without surgical treatment or a confirmed cancer diagnosis, 376 patients remained. Biopsy accuracy was defined as the histopathologic concordance between preoperative and permanent pathology. We assessed histopathologic concordance based on biopsy methods, including endoscopic biopsy at the outpatient department (OPD), endoscopic biopsy in the operating room (OR), endoscopic surgery, image-guided needle biopsy, and tumor sites. Pathologies were classified according to the International Classification of Diseases for Oncology (ICD-O) 3.2 morphology, and biopsy accuracy was compared. Chi-square, Fisher's exact test, and logistic regression were used for statistical analysis.

The overall histopathologic concordance rate was 91.8%. The sensitivity and positive predictive value of preoperative biopsy were 93.1% and 97.7%, respectively. Endoscopic surgery showed the highest histopathologic concordance rate (97.1%). In comparison, endoscopic biopsy in the OR and image-guided needle biopsy had lower histopathologic concordance rates of 91.1% and 87.5%, respectively, though these differences were not statistically significant. The frontal and sphenoid sinuses demonstrated lower histopathologic concordance rates (88.9%), which was also not statistically significant. Poorly differentiated carcinomas had significantly lower histopathologic concordance rates, but no factors influencing histopathologic concordance were identified.

No statistically significant association was detected between biopsy technique or tumor site and histopathologic concordance. Given the limitations of preoperative biopsies, additional imaging and diagnostic tools are crucial for accurate malignancy evaluation. Considering the possibility of misdiagnosis, permanent pathology should also be reviewed.