Abundant Biopsy Volume Reduces Risk of Nasoethmoidal Tumor Misdiagnosis

by ENTtoday •

How do the type of surgical procedure, volume of biopsy, tumor size, and location in the nasal fossa influence the reliability of pretreatment biopsies on nasoethmoidal tumors?

Bottom line
The risk of nasoethmoidal tumor misdiagnosis may be high even in referral centers. Obtaining abundant material under general anesthesia may reduce the risk of diagnostic error and inadequate treatment.

Background: Nasoethmoidal malignancies are rare diseases characterized by large histological variability. Pretreatment biopsy is crucial in histology-based management of malignant nasoethmoidal tumors because misdiagnosis can lead to inadequate therapeutic planning. The rarity of the disease and the wide range of histological variants explain the high rate of histologic discrepancies detected in sinonasal tumors after detailed revision by expert pathologists.

Study design: Retrospective case series of 77 patients from 252 cases, recorded from January 1995 to June 2016.

Setting: Unit of Otorhinolaryngology–Head and Neck Surgery of the University of Brescia, Italy.

Synopsis: Of all cases, 47 underwent biopsy under local anesthesia (OB), 12 underwent biopsy under local anesthesia and sedation (SB), and seven underwent biopsy under general anesthesia (GB). The average volume obtained was 2.0mL for OB, 3.2mL for SB, and 16.4mL for GB. The tumor was posterior and/or anterior to the middle turbinate basal lamella in 27.5% and 72.5%, respectively; lateral and/or medial to the middle turbinate in 10.3% and 89.7%, respectively; and in contact or not with the floor of the nasal cavity in 57.5% and 42.5%, respectively. There was no significant difference in OB and SB volume, but a statistically significant difference when OB and SB volume were compared with GB volume. Biopsy volume in cases with correct diagnosis was significantly higher than in cases with histologic discrepancies. Benign/inflammatory lesions, miscellanea, and squamous cell carcinomas (SCC) were significantly associated with a higher diagnostic discrepancy rate, whereas adenocarcinomas (ADC), germ cell tumors (GCT), mucosal melanomas (MM), olfactory neuroblastomas, salivary gland carcinomas (SGC), sarcomas, and sinonasal undifferentiated carcinomas were significantly correlated with a higher biopsy reliability rate. GCTs, SGCs, and sarcomas were significantly associated with lower concordance rate values, while ADCs, MMs, and SCCs showed a significantly higher concordance rate values. Limitations include the study’s retrospective nature, a limited number of cases, and a likely minimized rate of diagnostic error in a referral hospital.

Citation: Schreiber A, Rampinelli V, Ferrari M, et al. Diagnostic reliability of pretreatment biopsy in malignant nasoethmoidal tumors: a retrospective study of 77 cases [published online ahead of print January 4, 2018]. Laryngoscope. doi: 10.1002/lary.27077.