Early postoperative CT scanning for juvenile nasopharyngeal angiofibroma: detection of residual disease.
OBJECTIVE
High recurrence rates and early recurrence have been reported for juvenile nasopharyngeal angiofibroma (JNA) involving the skull base. The purpose of this study was to evaluate the diagnostic accuracy of contrast-enhanced CT scanning for the detection of residual disease (RD) in the early postoperative course after surgical excision of JNA.


METHODS
We retrospectively reviewed data in 20 male patients (mean age +/- SD, 15.4 +/- 5 years; range, 10-32 years) who underwent enhanced helical CT in the days after apparent complete surgical excision of JNA with initial expansion in the skull base. Four independent, blinded readers evaluated the occurrence of RD. Final diagnoses were rendered on the basis of histologic examination of excised specimens of RD or clinical and radiologic follow-up. The Cohen kappa test was performed to examine interreader agreement.


RESULTS
Postoperative contrast-enhanced CT had a sensitivity of 75%, a specificity of 83%, a positive predictive value of 75% and a negative predictive value of 83% for the detection of RD. The prevalence of RD was 40%. The base of pterygoids was the most frequent location of RD. Interreader agreement was high for the detection of putative RD (kappa=0.83). Variabilities in readers' interpretations were encountered for false-positive results and for disease in the foramen lacerum. False-negative results involved the base of pterygoids. Early postoperative CT scanning was well tolerated by all patients.


CONCLUSIONS
Contrast-enhanced helical CT is an accurate tool to evaluate excision of JNA in the days after surgery.
Kania
Romain E
RE
Department of Otorhinolaryngology-Head and Neck Surgery, Assistance Publique-Hôpitaux de Paris, Paris VII University, Lariboisière Hospital, France.
Sauvaget
Elisabeth
E
Guichard
Jean-Pierre
JP
Chapot
René
R
Huy
Patrice Tran Ba
PT
Herman
Philippe
P
D000293:Adolescent; D000328:Adult; D018322:Angiofibroma / Q000000981:diagnostic imaging / Q000601:surgery*; D000947:Antigens, Helminth; D002648:Child; D006801:Humans; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging; D018365:Neoplasm, Residual / Q000000981:diagnostic imaging* / Q000601:surgery; D015588:Observer Variation; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000601:surgery; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
D000947:Antigens, Helminth; C436518:DiAg protein, Dirofilaria immitis