Is planned surgery important in sinonasal inverted papilloma?
OBJECTIVE
To evaluate which clinical characteristics of inverted papilloma (IP) can result easily in misdiagnosis by clinicians and to determine the recurrence rate of inverted papilloma depending on diagnosis confirmation pre-operatively, intra-operatively or post-operatively.


METHODS
Fifty-one patients were treated for IP and 47 patients attended regular post-operative follow-up appointments for at least one year (mean: 54 months).


RESULTS
The patients were assigned to 3 groups: group Ia, in which IP was not confirmed until the post-operative pathology findings; group Ib, in which IP was confirmed during the operation; and group II, in which IP was confirmed before the operation. There were nineteen (37%) patients in group Ia, nine patients (18%) in group Ib and twenty-three patients (45%) in group II. The recurrence rates for groups Ia, Ib and II were 33%, 11% and 5% respectively.


CONCLUSIONS
The initial presentation of bilateral sinonasal disease can easily lead the doctor into the misdiagnosis of IP. Bony erosion, remodelling, and a widening of the natural orifice of the sinuses on a CT scan are useful signs indicating IP. The correct diagnosis prior to surgery is a determinant of outcome. The use of frozen sections should, however, improve outcome as well. In this study we highlight the high prevalence and relatively low control rate of misdiagnosed IP (pathology undetermined pre-operatively) and hope to remind clinicians that early recognition of the tumour is most beneficial to patients.
Chen
C M
CM
Department of Otorhinolaryngology, Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan.
Tsai
Y L
YL
Chang
C C
CC
Chen
H C
HC
Chen
M K
MK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003951:Diagnostic Errors; D055088:Early Detection of Cancer; D004724:Endoscopy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000453:epidemiology*; D009367:Neoplasm Staging; D018308:Papilloma, Inverted / Q000175:diagnosis* / Q000601:surgery*; D010255:Paranasal Sinus Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult