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October 2015TRIO Best Practice articles are brief, structured reviews designed to provide the busy clinician with a handy outline and reference for day-to-day clinical decision making. The ENTtoday summaries below include the Background and Best Practice sections of the original article. To view the complete Laryngoscope articles free of charge, visit Laryngoscope.com.
Background
Inverted papilloma (IP) is a benign tumor of the nasal cavity and paranasal sinuses first described by Ward in 1854. IP is remarkable due to a high propensity for tumor recurrence with incomplete resection, potential for invasion of local structures, and an association with malignant transformation to squamous cell carcinoma. Surgery is the mainstay of treatment for sinonasal IP, and the initial controversy over the best approach for tumor removal has been replaced by the widespread use of endoscopic techniques when feasible. What remains unclear is the best practice for surveillance following surgery for a tumor that carries low but well-known potential for malignant transformation.
Best Practice
Regular surveillance for IP facilitates the early identification of small, asymptomatic recurrences and provides a tool for earlier management of these recurrences. Although the majority of IP cases will recur in the first year, more than 25% can recur many years after surgery, and thus long-term follow-up is indicated. We advocate regular follow-up endoscopic examinations, especially for tumors that are HPV positive, higher T stage, or for patients with unresectable or residual IP due a higher risk of recurrence and malignant transformation. Surveillance schedules can be based on those used for HNSCC. A majority of IPs will recur in the first two years, but late recurrences are not uncommon. Locations that are difficult to endoscopically visualize postoperatively (i.e., the lateral frontal sinus) may be followed with serial MRI exams (Laryngoscope. 2014;124: 1981-1982).