Juvenile Nasal Angiofibromas: A Comparison of Modern Staging Systems in an Endoscopic Era.
ObjectivesTo compare the clinical utility of four juvenile nasal angiofibroma (JNA) staging systems in a large cohort of patients.DesignRetrospective case series.SettingTertiary referral academic center.ParticipantsPediatric patients undergoing surgical resection of JNAs between January 2008 and June 2015.Main Outcome MeasuresIntraoperative blood loss and transfusions, number of staged operations, postoperative residual disease, and recurrent disease.ResultsIn total, 34 patients were identified; all underwent preoperative embolization followed by surgery. Of the 34 patients, 33 (97%) underwent an exclusively endoscopic surgical approach, with 6 (18%) requiring planned staged operations. Ten (29%) patients had residual disease and three (9%) required further surgical resection. Using the area under the curve (AUC) of receiver operating characteristic curves, the University of Pittsburgh Medical Center (UPMC) staging system was most predictive of patients who required staged procedures, received intraoperative transfusions, and had residual postoperative disease (AUC: 0.89, 0.88, 0.86, respectively).ConclusionsThe UPMC JNA staging system accounts for both route of skull base extension and tumor vascularity, which are two important tumor attributes in the age of preoperative embolization and endoscopic endonasal surgery. The UPMC staging system is a reliable modern staging system that closely reflects prognostic information and aids in surgical planning.
Department of Otolaryngology, Eye & Ear Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States.
Nicholas R
NR
Rowan
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States.
Nathan T
NT
Zwagerman
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States.
Molly E
ME
Heft-Neal
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States.
Paul A
PA
Gardner
Department of Otolaryngology, Eye & Ear Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States; Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States.
Carl H
CH
Snyderman
angiofibroma; endoscopy; prognosis; retrospective study; skull base pathologies; standards; surgery