Abstract
The clinical benefit of pre-hematopoietic cell transplantation sinus CT screening remains uncertain, while the risks of CT radiation and anesthesia are increasingly evident. We sought to re-assess the impact of screening sinus CT on pretransplantation patient management and prediction of posttransplantation invasive fungal rhinosinusitis. Pretransplantation noncontrast screening sinus CTs for 100 consecutive patients (mean age, 11.9 ± 5.5 years) were graded for mucosal thickening (Lund-Mackay score) and for signs of noninvasive or invasive fungal rhinosinusitis (sinus calcification, hyperattenuation, bone destruction, extrasinus inflammation, and nasal mucosal ulceration). Posttransplantation sinus CTs performed for sinus-related symptoms were similarly graded. Associations of Lund-Mackay scores, clinical assessments, changes in pretransplantation clinical management (additional antibiotic or fungal therapy, sinonasal surgery, delayed transplantation), and subsequent development of sinus-related symptoms or invasive fungal rhinosinusitis were tested (exact Wilcoxon rank sums, Fisher exact test, significance P < .05). Mean pretransplantation screening Lund-Mackay scores (n = 100) were greater in patients with clinical symptoms (8.07 ± 6.00 versus 2.48 ± 3.51, P < .001) but were not associated with pretransplantation management changes and did not predict posttransplantation sinus symptoms (n = 21, P = .47) or invasive fungal rhinosinusitis symptoms (n = 2, P = .59). Pre-hematopoietic cell transplantation sinus CT does not meaningfully contribute to pretransplantation patient management or prediction of posttransplantation sinus disease, including invasive fungal rhinosinusitis, in children. The risks associated with CT radiation and possible anesthesia are not warranted in this setting.
Highlights
MethodsPretransplantation noncontrast screening sinus CTs for 100 consecutive patients (mean age, 11.9 6 5.5 years) were graded for mucosal thickening (Lund-Mackay score) and for signs of noninvasive or invasive fungal rhinosinusitis (sinus calcification, hyperattenuation, bone destruction, extrasinus inflammation, and nasal mucosal ulceration)
BACKGROUND AND PURPOSEThe clinical benefit of pre-hematopoietic cell transplantation sinus CT screening remains uncertain, while the risks of CT radiation and anesthesia are increasingly evident
Mean pretransplantation screening Lund-Mackay scores (n 1⁄4 100) were greater in patients with clinical symptoms (8.07 6 6.00 versus 2.48 6 3.51, P, .001) but were not associated with pretransplantation management changes and did not predict posttransplantation sinus symptoms (n 1⁄4 21, P 1⁄4 .47) or invasive fungal rhinosinusitis symptoms (n 1⁄4 2, P 1⁄4 .59)
Summary
Pretransplantation noncontrast screening sinus CTs for 100 consecutive patients (mean age, 11.9 6 5.5 years) were graded for mucosal thickening (Lund-Mackay score) and for signs of noninvasive or invasive fungal rhinosinusitis (sinus calcification, hyperattenuation, bone destruction, extrasinus inflammation, and nasal mucosal ulceration). With institutional review board approval and waiver of consent, imaging, clinical, ENT risk assessment, and laboratory data were prospectively recorded for 100 sequential participants who had pre-HCT screening sinus CT at our institution between June 2015 and April 2017. Clinic and Laboratory Recorded data included primary diagnosis; transplant donor type; absolute neutrophil count at imaging; pretransplantation imaging indication; development of posttransplantation graft versus host disease (GVHD) grades II–IV (moderate-to-life-threatening); pretransplantation galactomannan (Aspergillus antigen); sinonasal symptoms (rhinorrhea, congestion, nasal/facial pain, swelling, visible nasal lesion), or fever at pretransplantation evaluation; and changes to pretransplantation management (changes in fungal prophylaxis regimen, addition of antibiotics, sinonasal operation, or delay of HCT) attributable to screening sinus CT. These findings were summarized as “at-risk” or “not at-risk” for IFRS
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