Routine histopathology in uncomplicated sinus surgery: is it necessary? Otolaryngol Head Neck Surg 2005 Mar;132(3):407-12; discussion 413
Date
03/05/2005Pubmed ID
15746852DOI
10.1016/j.otohns.2004.10.002Scopus ID
2-s2.0-14744273904 (requires institutional sign-in at Scopus site) 25 CitationsAbstract
OBJECTIVE: To evaluate the incidence of occult pathology in routine, uncomplicated endoscopic sinus surgery, and to suggest guidelines for when to send specimens for histopathologic exam.
STUDY DESIGN AND SETTING: Retrospective analysis of case records of 790 patients who underwent 868 endoscopic sinus surgeries at a tertiary care center from 1986 to 2003. Indications were chronic sinusitis, recurrent acute sinusitis, nasal polyposis, or combinations of these diagnoses. All cases were considered routine and did not involve preoperative suspicion of neoplasm or other complicating factors. Charts were reviewed for surgical indication, patient age, laterality of disease, history of prior sinus surgery, intraoperative suspicion of tumor, and final histopathology.
RESULTS: In 868 cases of endoscopic sinus surgery, occult neoplasm was diagnosed in 2 patients (0.23%). In one patient, the initial surgery cured the lesion. Final histopathology of the remaining 866 (99.8%) specimens was consistent with inflammation and/or nasal polyposis. In 121 cases of unilateral sinusitis, none was positive for neoplasm. In 277 cases involving bilateral nasal polyposis and 13 involving unilateral polyposis, no neoplasms were found. Intraoperative suspicion of neoplasm occurred in 12 cases, with all specimens read as consistent with sinusitis and/or polyposis.
CONCLUSIONS: Histopathologic review of every specimen obtained in routine sinus surgery for sinusitis and/or nasal polyposis is not indicated. Submission of specimen is indicated in routine cases when: 1) there is intraoperative suspicion of tumor, 2) unilateral nasal polyposis is present, 3) unilateral sinus opacification is present, and 4) additional diagnostic information is needed (eg, presence of eosinophils, fungal forms, etc.).
SIGNIFICANCE: Establishes a safe and reasonable standard of care, with potential cost savings and medico-legal ramifications.
Author List
Romashko AA, Stankiewicz JAAuthor
Alexander A. Romashko MD Assistant Professor in the Otolaryngology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Aged, 80 and over
Child
Child, Preschool
Female
Humans
Incidence
Infant
Male
Middle Aged
Paranasal Sinus Neoplasms
Paranasal Sinuses
Retrospective Studies
