Is intraoperative margin sampling necessary in inverted papilloma resection?

PURPOSE: To explore the association between intraoperative surgical margin sampling by the frozen sections and recurrence in inverted papilloma surgery. METHODS: A multicenter, retrospective study of patients who underwent attachment-oriented IP resection in four tertiary care medical centers with a minimal follow-up of 36 months. RESULTS: The study included 220 surgeries with a mean follow-up period of 49 months (range 36-204). The endoscopic approach was used in all but 4 cases; 73% of procedures were primary. Overall recurrence was 10.45% (n = 23). Squamous cell carcinoma was found in 5 cases (2.2%). Intraoperative margin sampling was obtained in 145 cases. There was no difference in the recurrence rate between frozen section and no-frozen section groups (p = 0.44). Furthermore, margin sampling in various sites of tumor origin, in cases with concomitant nasal polyps (p = 0.53) and in revision cases (p = 0.08) showed no correlation with recurrence. In 26 cases when the surgery was extended following a positive frozen section, there was a significantly higher recurrence rate (OR = 6.94). CONCLUSIONS: According to our results, intraoperative margin sampling did not affect the recurrence rate of IP, and therefore, its routine use should be questioned.

Endoscopic Resection of Sinonasal Inverted Papilloma: A Multivariate Retrospective Analysis of Factors Affecting Recurrence and Persistence.

Sinonasal inverted papilloma (IP) is the most common benign epithelial tumor in the nasal cavity and paranasal sinuses, with a worldwide incidence between 0.6 and 1.5/100 000 persons per year. However, only a few studies have investigated patient-dependent factors related to IP recurrence and persistence. According to available evidence, these factors are still debated, and results are contradictory. In this multicenter retrospective study, we analyzed the clinical records of 130 patients who were surgically treated for sinonasal IP to evaluate the factors affecting recurrence and persistence of IP and compared the curative rates of different surgical approaches. Our analysis showed that IP recurrence is strongly related to specific risk factors including incomplete surgical removal, stage of disease, site of the lesion, surgical technique, and malignancy rate. In conclusion, the recurrence of IP may be affected by several risk factors; these factors must be carefully considered during clinical evaluation and especially during the follow-up of patients with IP.

Correlation between Objective and Subjective Assessment of Nasal Patency.

INTRODUCTION: This study was performed to evaluate the correlation between the objective and subjective sensation of nasal patency, assessed through a validated questionnaire, the Italian version of the NOSE scale, and the rhinomanometric results in a large cohort of patients complaining about nasal obstruction. MATERIALS AND METHODS: Data was obtained from a total of 233 adult patients, (123 males, 110 females, with a mean age of 43.7 years) with a diagnosis of septal deviation and complaining about nasal obstruction. Anterior active rhinomanometry was used for objective assessment, while the I-NOSE scale and a visual analog scale (VAS) were used for subjective evaluation. RESULTS: Positive correlations between I-NOSE scores and VAS and rhinomanometric results were found. The higher correlation was demonstrated between the HUNR (higher unilateral nasal resistance) parameter of rhinomanometry and the second item of the I-NOSE scale (Nasal blockage or obstruction). No significant correlation was found between the fourth item of the I-NOSE (Trouble sleeping) and the VAS score. The VAS score appeared mildly, but still significantly, correlated with the HUNR parameter of rhinomanometry. CONCLUSION: The correlation between the subjective sensation of nasal patency and the rhinomanometric data proved to be significant. No correlation between subjective sensation of trouble sleeping and rhinomanometric assessment was found. In counselling with patients complaining of nasal obstruction trouble in sleeping should not be considered as a symptom related to nasal obstruction.

Reliability and validity of the Italian nose obstruction symptom evaluation (I-NOSE) scale.

The NOSE scale is a questionnaire assessing QOL related with nasal obstruction. The aim of this study was to culturally adapt the NOSE scale into Italian (I-NOSE). Prospective instrument validation study. Cross-cultural adaptation and validation were accomplished. Cronbach α was used to test internal consistency in 116 patients complaining nasal obstruction and 232 asymptomatic subjects. Pearson and ICC tests were used for test-retest reliability analysis. Normative data were gathered from the 232 asymptomatic subjects. Mann-Whitney test was used to compare the I-NOSE scores in patients and asymptomatic subjects and in 40 patients before and after septoplasty. I-NOSE scores obtained in 60 patients were correlated with rhinomanometric results and with the score of a visual analog scale (VAS) measuring the subjective sensation of nasal obstruction. Good internal consistency and good test-retest reliability were found. I-NOSE mean score of the normal cohort was 12.1 ± 13.2. Asymptomatic subjects scored lower than patients with nasal obstruction (p = 0.001). Positive correlations between I-NOSE scores and VAS and rhinomanometric results were found. The mean I-NOSE score improved from 64.4 ± 23.6 to 22.1 ± 13.5 after septoplasty (p < 0.001). The I-NOSE scale is a reliable, valid, self-administered, symptom-specific questionnaire; its application is recommended.