Site of Attachment of Inverted Papilloma Predicted by CT Findings of Osteitis

Abstract

The treatment of choice for sinonasal inverted papilloma (IP) is surgical resection, which typically includes identification of the site of origin with appropriate inclusion or management of this site in the surgical resection. Appropriate preoperative planning is thus of significant importance and will routinely include CT imaging and nasal endoscopy. The aim of this study was to determine whether findings of osteitis in the patients' preoperative CT images could predict the site of attachment. This bipartite study contained both retrospective and prospective arms. For the retrospective arm, preoperative CT images of all cases were reviewed electronically in a blinded fashion by the senior author and a prediction was made for the site of attachment. The actual site of attachment as documented in the operative note was then compared with the predicted site. A similar process was followed for the prospectively acquired patients except that the site of attachment was predicted preoperatively. Twenty-eight retrospective and six prospective patients were identified as eligible for the study. Six retrospective patients were excluded because of incomplete data. In patients that were reviewed retrospectively, osteitis was seen in 20/22 patients and was used to correctly predict the site of attachment in 18/20 times. Of the prospectively acquired patients osteitis was seen in 5/6 patients with the site of attachment predicted in 4/5 patients. In patients in whom osteitis is detectable on the preoperative CT scan, the site of origin of the IP can be predicted with a high degree of accuracy.