Integrating Preoperative Imaging, Intraoperative Findings in Maxillary Sinus Floor Infiltration Assessment in Patients with Maxillary Cancer

by Linda Kossoff •

In cases of maxillary cancer, what are the challenges involved in the preoperative and intraoperative evaluation of maxillary sinus floor (MSF) infiltration, and what are their prognostic relevance?

BOTTOM LINE

Preoperative imaging should be integrated with intraoperative findings based on endoscopic inspection and frozen sections in patients with maxillary cancer.

BACKGROUND: Disappointing overall survival (OS) rates for maxillary sinus cancer are mainly due to diagnostic delay but are also reported for early-stage tumors. Such tumors may involve critical areas such as the MSF, requiring invasive transfacial resections. The prognostic impact of MSF involvement in maxillary sinus cancer has not been properly investigated, however.

STUDY DESIGN: Retrospective case series.

SETTING: Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy.

SYNOPSIS: Researchers conducted a retrospective review of 118 patients receiving surgical-based treatment for primary maxillary sinus cancers at a single institution between January 2000 and November 2019, with the intent of using the least invasive approach required to complete excision. The team obtained and reviewed all patients’ imaging studies to assess the presence of MSF involvement. They found that, comparing intraoperative findings (endoscopic assessment and frozen sections) with preoperative radiological assessment, diagnostic changes regarding MSF infiltration were found in 27.1% of cases. Of all patients, 78.8% were affected by tumors staged at least pT3, with MSF trespassing the bony boundaries of the maxillary sinus. Analysis showed that MSF infiltration was significantly associated with reduced rates of OS, disease-free survival, local recurrence-free survival, and distant recurrence-free survival, suggesting that MSF infiltration might independently negatively impact survival and local control rate. Authors state that future studies are required to investigate the opportunity to incorporate MSF infiltration in the Tumor Nodes Metastasis staging system. Limitations of this study included its retrospective nature and a simplified histological classification of tumors.

CITATION: Arosio AD, Turri-Zanoni M, Sileo G, et al. Maxillary sinus floor infiltration: Results from a series of 118 maxillary sinus cancers. Laryngoscope. 2022;132:26-35.