title: Paranasal sinus and skull base fibro-osseous lesions: when is biopsy indicated for diagnosis?
abstract: BACKGROUND
  Paranasal sinus fibro-osseous (FO) lesions represent a heterogeneous group, often sharing overlapping radiographic and pathologic features posing a dilemma in accurate diagnosis. The objective of this study was to correlate preoperative radiologic and postoperative histologic diagnosis to help guide a diagnostic algorithm.
  
  
  METHODS
  Retrospective analysis of 60 FO lesions between 1994 and 2010.
  
  
  RESULTS
  The mean age was 42.3 years with average follow-up of 12.5 months. The preliminary radiologic diagnosis was osteoma in 22 (36.7%), fibrous dysplasia (FD) in 9 (15%), ossifying fibroma (OF) vs FD in 5 (8.3%), and OF in 3 (5%) cases. The diagnosis was indeterminate in 21 (35%) cases. Management consisted of excision in 29 (48.3%), observation in 17 (28.3%), and biopsy in 14 (23.3%) patients. For patients undergoing resection or biopsy, positive predictive value of preoperative radiology was 100% (10/10) for osteoma, 85.7% (6/7) for FD, and 33.3% (1/3) for OF cases. For the indeterminate lesions, most common pathologic diagnoses for 21 patients included osteoma in 4 (17.4%), arrested pneumatization in 3 (14.3%), OF in 3 (14.3%), and FD in 2 (9.5%). For FD vs OF cases, 3 underwent surgery, revealing osteoma, FD, and OF in 1 patient each.
  
  
  CONCLUSIONS
  In this series, radiologic-histopathologic correlation was high for osteoma and FD and low for OF and OF vs FD. This data suggests that patients with classic radiologic characteristics of osteoma and FD may be observed, unless resection is warranted based on clinical symptomatology. Preoperative diagnosis of OF, OF vs FD, or indeterminate lesions may warrant a biopsy to establish firm diagnosis to guide definitive management, especially if preoperative computed tomography (CT) imaging is concerning for an aggressive FO neoplasm.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
authors.forename: Guy
authors.initials: G
authors.lastname: Efune
authors.forename: Carlos L
authors.initials: CL
authors.lastname: Perez
authors.forename: Liyue
authors.initials: L
authors.lastname: Tong
authors.forename: Jordan
authors.initials: J
authors.lastname: Rihani
authors.forename: Pete S
authors.initials: PS
authors.lastname: Batra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D001706:Biopsy; D002648:Child; D005260:Female; D018214:Fibroma, Ossifying / Q000000981:diagnostic imaging* / Q000473:pathology; D005357:Fibrous Dysplasia of Bone / Q000000981:diagnostic imaging* / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010016:Osteoma / Q000000981:diagnostic imaging* / Q000473:pathology; D010255:Paranasal Sinus Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult