Management Of Sinonasal Inverted Papilloma Research Articles

Exclusive Endoscopic Approach in the Management of Sinonasal Inverted Papilloma.

The online version contains supplementary material available at 10.1007/s12070-022-03332-6.

Diagnostic strategy and therapeutic management of sinonasal inverted papilloma: our experience with review of literature

BackgroundThe sinonasal inverted papilloma is a rare benign tumor, characterized by local aggressiveness, a high rate of recurrence after surgical resection, and the possibility of malignant transformation. The aims of this study are to analyze diagnostic strategy and therapeutic modalities and to evaluate results after surgery.MethodsWe report a retrospective study, including patients operated for inverted sinonasal papilloma in our department. Preoperatively, all patients were assessed by CT scan (computed tomography), 9 of them by MRI (magnetic resonance imaging).ResultsThe average age of our patients was 52 years with a male predominance. The most common symptom was unilateral nasal obstruction. The endoscopic appearance was suggestive of inverted papilloma (IP) in 75% of cases. Thirty-two patients underwent an exclusive endonasal endoscopic surgery; one patient was operated with a combined approach. Two patients underwent external approaches. A recurrence was observed in 4 patients (11%).ConclusionPreoperative investigation for IP is essentially based on MRI, also required in case of recurrence. Histological examination of the entire tumor is crucial to rule out an associated carcinoma. The “all endoscopic” management is not always achievable for these tumors.

Association of the human papillomavirus infection with the recurrence of sinonasal inverted papilloma: a systematic review and meta-analysis.

Although the role of human papillomavirus (HPV) in sinonasal inverted papilloma (SNIP) has been investigated, the link between HPV infection and SNIP recurrence remains controversial. This meta-analysis aimed to investigate the association between HPV infection and recurrence of SNIP. The PubMed, Web of Science, Google Scholar, and Cochrane Library databases were searched (until 16 June 2021) to collect all relevant articles. The pooled odds ratio (OR) with 95% confidence interval (CI) was calculated using the fixed effects model. In addition, subgroup analysis, assessment of publication bias, and sensitivity analyses were performed. Fourteen eligible articles, including 592 patients with SNIP, were included in this study. Pooled analysis revealed that HPV-positive cases exhibited a significantly higher OR of tumour recurrence than HPV-negative counterparts). A significant association between HPV infection and tumour recurrence remained stable in subgroup analyses according to the publication year of the studies. Our meta-analysis demonstrates that HPV infection is significantly associated with the recurrence of SNIP, suggesting the pathological role of HPV in SNIP. These results suggest that HPV infection should be considered in the management of SNIP.

Endoscopic Modified Danker's Approach for Management of Sinonasal Inverted Papilloma: Our Experience.

Sinonasal inverted papilloma (SNIP), Inverting papilloma, Schneiderian papilloma etc. It is a benign tumor with incidence nearly 70% of all sinonasal papilloma and 0.5-4.0% of all sinonasal neoplasms. The most common site of origin is lateral nasal wall and common presenting symptom is nasal obstruction followed by epistaxis. On histopathology examination, it is characterized by invagination of neoplastic epithelium into underlying stroma. With the advent of technology, the endoscopic modified dankers approach became the surgical approach of choice. The present study was undertaken to study its role in management of SNIP with reference to rate of recurrence and malignancy. An observational study was conducted in a tertiary health center in which 40 biopsy proven cases of SNIP, operated by endoscopic assisted modified Danker's approach between September 2008 and January 2019 with minimum follow-up period of 6months were analyzed. Male:Female ratio was 2.33:1. The most common symptom was nasal obstruction (97.5%) followed by rhinorrhoea (87.5%). Using various imaging and diagnostic measures, lateral nasal wall was found to be the most common site of origin. Out of total 40 cases, 9 (27.5%) patients had recurrence, of these, 6 were benign and remaining 3 had malignancy as confirmed by biopsy. Most of the cases of SNIP can be managed endoscopically, although extensive lesions or the lesions with malignant transformation, external approach may be needed so expertise in both endoscopic and conventional techniques is needed. Although most of the recurrences occurred in first 2years, but life time follow-up is advisable.

Clinical Outcomes and Management of Sinonasal Inverted Papilloma

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Sinonasal inverted papilloma recurrence rates and evaluation of current staging systems.

Sinonasal inverted papillomas (SNIPs) are benign epithelial growths with high recurrence rates after surgical management. This study aims to evaluate SNIP recurrence rates after endoscopic surgery and to provide a comparison of published staging systems. This chart review evaluated primary and revision SNIP cases from January 2008 to December 2016 at a tertiary sinus centre. Data was collected on patient demographics, origin site, surgical approaches, follow-up duration, recurrence, and smoking history. Each case was staged using Krouse, Oikawa, Cannady, Han, and Kamel systems. 52 primary and 22 revision SNIP patients had a mean follow-up of 42.3 (range:3-55) months. 11 primary cases (21.1%) and 5 revision cases (22.7%) had recurrences. Primary and revision cases had a mean time to recurrence of 24.0 (range:3-55) and 14.6 (range:10-20) months respectively. Smoking history had an OR of 0.63 (CI 95%: 0.18-2.22) for recurrence. The age group of 20-39 years featured the highest rates of recurrence. Patient groups defined by each staging system were compared by Kaplan-Meier survival analyses and logrank tests. Chi-squared values for Krouse, Oikawa, Cannady, Han, and Kamel systems were 6.73, 7.02, 6.19, 8.23 and 3.29, respectively. Recurrence rates found in this study are comparable to published literature. No statistical significance was found to associate smoking with recurrence. Han and Cannady staging systems were found to define patient groups that correlated well with recurrence. Staging systems should play a role in the management of SNIPs, especially to identify patients requiring additional post-surgical monitoring.

Bone involvement: Histopathological evidence for endoscopic management of sinonasal inverted papilloma.

The aim of this study is to provide histopathological evidence for a better understanding of the excision of bone underlying tumor. Retrospective study. Thirty patients with histopathological diagnosis of sinonasal inverted papilloma (SIP) were enrolled. All patients underwent preoperative radiography to define the tumor location. The primary tumor and underlying bone, removed during endoscopic surgery, were examined under microscope. Twenty-five of 30 specimens exhibited bony hyperostosis on computed tomography (CT) images, and 12 of 30 specimens showed evidence of bony lamellar erosion. Both coexisted in 11 cases. Half of the relapse cases (8 of 16) presented bone discontinuity on CT, which indicates a higher propensity for bone involvement when compared with primary SIP. On histopathology, 26 cases presented hyperostosis and 11 cases showed bone invasion. In total, 90% of cases covered both. Sixteen cases showed a growing tendency of inflammatory cells infiltration. Histopathological evidence of bone involvement indicates the importance of removal of the underlying bone at the time of endoscopic tumor resection. We hypothesized that bone involvement including bone invasion and osteogenesis may be induced by the tumor, and any microscopic lesion in the bony crevices probably indicates recurrence of SIP. Furthermore, infiltration of inflammatory cells may facilitate bone involvement and cause recurrence. NA. Laryngoscope, 127:2703-2708, 2017.

Endoscopic surgical management of sinonasal inverted papilloma extending to frontal sinuses.

Sinonasal inverted papilloma has been traditionally managed with external surgical approaches. Advances in imaging guidance systems, surgical instrumentation, and intraoperative multi-visualization have led to a gradual shift from external approaches to endoscopic surgery. However, for anatomical and technical reasons, endoscopic surgery of sinonasal inverted papilloma extending to the frontal sinuses is still challenging. Here, we present our experience in endoscopic surgical management of sinonasal inverted papilloma extending to one or both frontal sinuses. We present 10 cases of sinonasal inverted papilloma extending to the frontal sinuses and successfully removed by endoscopic median drainage (Draf III procedure) under endoscopic guidance without any additional external approach. The whole cavity of the frontal sinuses was easily inspected at the end of the surgical procedure. No early or late complications were observed. No recurrence was identified after an average follow-up period of 39.5 months. Use of an endoscopic median drainage approach to manage sinonasal inverted papilloma extending to one or both frontal sinuses is feasible and seems effective.

Prediction of the Attachment Site of Sinonasal Inverted Papillomas by Preoperative Imaging

Accurate preoperative identification of the attachment site is the key to the successful surgical management of sinonasal inverted papillomas (IPs). This study investigated the value of preoperative imaging to identify the attachment sites of IPs. We analyzed I 0 consecutive patients with pathologically proven IPs. Two radiologists predicted the attachment sites of IPs from computed tomography (CT), 3.0 Tesla magnetic resonance imaging (3.0T MRI), 1.5T MRI, and CT plus 3.0T MRI. The actual tumor attachment sites were confirmed via pathological examination of specimens and compared with the predicted sites. Computed tomography showed the highest sensitivity (P < .0001), although both MRI formats showed greater specificity (P < .0001). The sensitivity of MRI plus CT was equal to that of CT and better than that of MRI (P < .0001), whereas its specificity was better than that of CT (P < .0001) and comparable to that of MRI. Prediction using 3.0T MRI appeared slightly superior to that using 1.5T MRI in terms of sensitivity and specificity, although the differences were not significant. Computed tomography and MRI had different features for prediction of sinonasal IP attachment sites. Preoperative CT plus MRI provided more useful information than CT or MRI alone.

Nasal endoscope: an armamentarium in the management of sinonasal inverted papilloma.

Sinonasal inverted papillomas (SIP) are unique group of locally aggressive benign neoplastic lesions arising from mucosa of sinonasal tract with potential for recurrences and known association with squamous cell carcinoma in 5-15% of cases. This study was conducted was to assess the efficacy and usefulness of the nasal endoscope in treating SIP. We reviewed 28 biopsy proven cases of SIPs that were treated at our hospital between June 2009 and September 2013. Average patient age was 46years. Fourteen were treated by transnasal endoscopic excision of tumor with noted recurrence of 21.43%. Thirteen were treated by endoscopic assisted open surgery which had 23% recurrence. Three patients had malignant inverted papillomas, of whom two (7%) were found to have synchronous squamous cell carcinoma and one (3.6%) had metachronous squamous cell carcinoma. No evidence of recurrence was found in rest during our follow up. The endoscopic approach is the preferred method for the treatment of the majority of inverted papillomas. Powered instrumentation is extremely useful to achieve good results. Although significant number of cases was done by external approach by lateral rhinotomy, the endoscopic assistance is required to ensure complete removal of the tumour to reduce the recurrence rates. Close follow up of the patient for a longer period of time is necessary for the early detection of recurrence and to allow for surgical salvage.

Optimal Endoscopic Management of Sinonasal Inverted Papilloma: Recurrence‐Free Experience with Twenty‐one Patients

Objectives: 1) Explore developments in endoscopic techniques and their application in the management of Sinonasal Inverted Papilloma (SNIP). 2) Describe 0% recurrence rates with aggressive endoscopic resection of complex SNIP. Methods: Retrospective single-center patient cohort analysis of twenty-one cases of SNIP treated by endoscopic resection at Charing Cross Hospital from December 2002 to September 2012. Pre-operative assessment included tomography or magnetic resonance imaging and biopsies. The origin and extent of the tumor determined the surgical strategy, and a combination of antrostomy, ethmoidectomy, sphenoidotomy, and endoscopic medial maxillectomy (EMM) with the assistance of angled instrumentation were performed. Sub-periosteal dissection followed by diamond burr drilling of the underlying bone were performed in all cases. All patients were followed up by regular endoscopic surveillance. Results: The study group consisted of 12 (57%) male and 9 (43%) female patients with a mean age of 59 years. Eleven patients (52%) had undergone previous surgery. Association with malignancy was seen in 2 patients (excluded from this study). All patients were treated by pure endoscopic means without adjunctive procedures. Completion surgery was performed on 1 patient with residual disease and histological atypia identified early after the operation. No recurrences were observed after a mean follow-up of 25 months. Conclusions: Our experience is one of the largest single-center recurrence-free case series for SNIP treated by pure endoscopic resection. It further supports the efficacy and safety of this technique even in complex recurrent cases and advocates its use as the gold standard first line surgical strategy.

Sinonasal Inverted Papilloma and the Dilemma of Treatments

ABSTRACT This is a review of most recent literature to find the best methods for management of sinonasal inverted papilloma and if there is any standardized modality/modalities. Also there is concern about the advancement in the management of sinonasal inverted papilloma based on recent literature revision. Inverted papilloma has to be managed aggressively from the beginning putting in mind its ability to recur and malignant transformation. Until now days there is no single verified modality of treatment and the choice of the best approach is tailored to every case. How to cite this article Al-Qahtani BM, Al-Amro MS. Sinonasal Inverted Papilloma and the Dilemma of Treatments. Clin Rhinol An Int J 2013;6(2):61-63.

Endoscopic Management of Sinonasal Inverted Papilloma with CT-navigation

Endoscopic Management of Sinonasal Inverted Papilloma with CT-navigation

Surgical Management of Sinonasal Inverted Papilloma

Despite benign histological features, inverted papilloma (IP) of the sinonasal tract is aggressive, with local bone erosion and paranasal extent and high risk for local recurrence and associated malignancy. An external approach through a lateral rhinotomy is the gold standard of surgery, but surgical advances suggest that endonasal resection is a viable alternative. We retrospectively analyzed 35 cases of histologically confirmed IP treated from January 1987 to December 2007. The 22 men and 13 women had a mean age of 59 years (range: 18-78). Endoscopic procedures were conducted on 22 sides (63%). An external approach was taken on 13 sides (37%). Local recurrence rate was 27% (6/22) with endoscopic procedures and 31% (4/13) with an external approach. IP-associated malignancy (squamous cell carcinoma) was found in two cases (6%).Endoscopic and external approaches thus both achieve radical excision of tumors with similar recurrence rates.Our experience suggests the importance of selecting the approach appropriate for complete tumor resection.

Management of Sinonasal Inverted Papillomas and Comparison of Classification Staging Systems

The aim of this study was to describe treatment results in patients with sinonasal inverted papilloma and to compare recent classification staging systems. We performed a retrospective study of 79 patients with primary paranasal sinus inverted papilloma from 1978 to 2008. The median age at diagnosis was 59 years. There were 68 men (86%) and 11 women (14%). Sixty inverted papilloma (76%) were located in the ethmoidal sinus complex, 16 (20%) were in the maxillary sinus, 2 were in the sphenoid sinus (3%), and 1 was in the septum (1%). Malignancy was simultaneously associated in four cases (5%). Intracranial extension was found in five patients (6%) and we did not find orbital content involvement. The external approach was used in 22 cases (28%) and 57 patients were treated with endoscopic nasal resection (72%). The overall recurrence rate in the total population was 21%. Recurrences were observed in 7 cases (32%) in the group of patients who received external approach and in 10 (17%) patients in the endoscopic group. Recurrences according to the Krouse system were 0% in T1 stage, 16% in T2 stage, 25% in T3 stage, and 60% in T4 stage (p = 0.05). Recurrences for groups A, B, and C stages using the Cannady staging system were 12, 26, and 60%, respectively (p = 0.039). Recurrences according to Han's system were 19% in both T1 and T2, 20% in T3, and 60% in T4 (p > 0.05). Our results support the endoscopic approach as the treatment of choice when feasible in patients with inverted papilloma, combined in selected cases with external approaches. The Krouse and Cannady systems provided a good distribution of patients according to local control.

Management of sinonasal inverted papilloma: our experience

Background and Objectives: Inverted papillomas (IPs), although histologically benign, are aggressive lesions that may recur after excision. This study describes the surgical experience of 32 patients with IP of paranasal sinuses treated at our institution and its recurrence rate after (at least) a year of follow-up.

The role of endoscopic sinus surgery in the management of sinonasal inverted papilloma

Inverted papilloma are benign sinonasal tumors that have a propensity to recur after surgical resection and may undergo malignant transformation. For this reason, complete resection is essential for the successful management of these tumors. Advances in endoscopic techniques and experience, as well as improved radiologic accuracy and navigation, are increasing the role of minimally invasive, endoscopic approaches for surgical resection of inverted papilloma. The following represents a review of the important and recent literature on the pathophysiology, diagnosis, and management of inverted papilloma. Studies of altered epithelial cell proliferation and cell cycle regulation have elucidated mechanisms of inverted papilloma pathogenesis. Radiographic findings, such as thickening of bone or osteitis, have been demonstrated to be useful in determining preoperative staging and for surgical planning. Outcomes studies suggest that endoscopic and combined endoscopic/external approaches now equal the effectiveness of traditional open procedures with decreased morbidity and reduced hospital stays. A better understanding of alterations in epithelial cell proliferation and cell cycle regulation in inverted papilloma may lead to adjuvant medical therapies to decrease recurrence rates and improve treatment. Endoscopic approaches continue to gain acceptance and have become the standard of care for resection of sinonasal inverted papillomas.

S278 – Management Strategies for Sinonasal Inverted Papilloma

Objectives 1) To compare endoscopic and external approaches in the management of sinonasal inverted papilloma at our institution. 2) To discuss the relationship of these management strategies to disease stage and malignancy. Methods Retrospective chart review of 18 patients who had operations performed to remove sinonasal inverted papilloma. Demographic, imaging and intraoperative data were collected from clinic charts. All patients had a definitive procedure performed between 2001 and 2007, with preoperative staging by CT, MRI or both. The primary outcome measure was recurrence and secondary outcome measures included association with malignancy and intraoperative complications. Results CT and MRI scanning were utilized for staging in 88% and 53% of cases, respectively. Mean follow-up was 16.3 months. All T1 lesions were managed by functional endoscopic sinus surgery (FESS). 71% of T3 lesions were managed by transnasal endoscopic medial maxillectomy (TEMM). 33% and 67% of large T3 and T4 lesions were managed with external procedures and TEMM, respectively. Recurrence rates for T1, T3, and T4 lesions were 0%, 16.7%, and 100%, respectively. Recurrence by surgical method were 0%, 18% (1 T3 and 1 T4), and 0% for FESS, TEMM and external approaches, respectively. Conclusions Inverted papilloma tended to present at more advanced stage. T1 and T3 lesions were generally managed by FESS and TEMM, respectively. Large T3 and T4 lesions were generally managed via external approaches or required further definitive management via an external approach. MRI, especially with frontal disease, may augment CT scanning, identifying true tumor mass, and thus provide indications for or against supplementary procedures.

Preoperative Staging and Surgical Approaches for Sinonasal Inverted Papilloma

We sought to determine the value of preoperative staging by magnetic resonance imaging (MRI) assessment in the surgical management of sinonasal inverted papillomas (IPs). Preoperative MRI staging was used to assess 22 patients with IPs. In addition to the Krouse staging system, T3 cases were categorized as subgroup T3-B if tumors extended into the frontal sinus or the supraorbital recess; otherwise, they were categorized as T3-A. Standard endoscopic sinus surgery (ESS) was the first choice for T1 and T2 cases. Endoscopic approaches, including ESS combined with endoscope-assisted transantral approach and endoscopic medial maxillectomy, were considered in T3-A cases, and external approaches were considered in T3-B cases. Patients were followed for a minimum of 1 year after surgery. Preoperative MRI staging and postoperative staging were coincident in 21 of the 22 patients (95%). All 8 T2 cases were treated by an endoscopic approach. Of 10 T3-A cases, 9 (90%) were treated by an endoscopic approach and 1 (residual case) was treated by an external approach. All 3 of the T3-B cases underwent an external approach. One T4 case with malignant transformation underwent an external approach followed by radiotherapy. After a median follow-up period of 22 months, none of the 22 patients had had a recurrence. No major complications were observed after endoscopic approaches, but epiphora or hemorrhage requiring transfusion occurred in 3 of the 5 patients (60%) who underwent external approaches. Preoperative staging of IP by MRI is useful for selecting cases that can be managed by endoscopic approaches, resulting in lower rates of tumor recurrence and morbidity.

Surgical management of sinonasal inverted papillomas through endoscopic approach

We defined a standardized approach to surgery of sinonasal inverted papillomas (IP) for adequate and safe resection. A cohort of 65 patients treated from January 1995 to December 2005 at a single institution was retrospectively analyzed (mean follow-up: 28 months; range 1-132). The extension of the tumor was evaluated on clinical findings and computed tomography (CT) scan and/or resonance magnetic imaging (RMI). External and endoscopic surgical approaches were compared according to tumor extension, rate of local recurrence. Univariate analysis was used to review the impact on disease-free survival of factors related to the histopathological findings and the treatment. Endoscopic (alone or combined with transantral approach) and external surgery were used in 46 patients (71%) and 19 patients, respectively. Endoscopic approach (34/46) was performed to control IP in the nasal fossa, the ostiomeatal complex, the sphenoid sinus. It was combined with Caldwell-Luc procedure (12/46) for tumor extent into the lateral part of the maxillary sinus. The mean time for recurrences to occur was 19 months with range of 5-35 months. The rate of local recurrence was 17.6% (6/34) in endoscopic approach alone, 8.3% in endoscopic approach combined with a Caldwell-Luc procedure and 15.8% (3/19) in external approach. Tumor extension, excision with safe margins, associated malignancy or dysplasia have no significant impact on disease-free survival regardless of surgical procedure. On the basis of imaging evaluation and peroperative view of tumor extent, we propose a surgical strategy in which endoscopic approach could be used on the first attempt by trained surgeons. RMI is very useful to determine acute extent of the disease.