Relationship between 18FDG-PET and different types of sinonasal malignancies.

CONCLUSION: The sensitivity and specificity of a 18FDG-PET scan may be different according to the histology. The SUVmax and SUV ratio may reflect the tumor's aggressive behavior. OBJECTIVES: To describe the characteristics of PET/CT scans, including the maximum standard uptake values (SUVmax), at initial diagnosis according to six main types of sinonasal malignancies: sinonasal adenocarcinoma (SNAC), sinonasal undifferentiated carcinoma (SNUC), adenoid cystic carcinoma (ACC), sinonasal malignant melanoma (SMM), olfactory neuroblastoma (ONB), and sinonasal neuroendocrine carcinoma (SNEC). METHODS: A chart review of 50 patients who were diagnosed and treated for six sinonasal malignancy types over a period of 6 years was conducted. Any 18F-FDG PET/CT scans for each patient were searched using the hospital's intranet. The SUVmax of the primary sinonasal site was recorded. The liver SUVs were utilized as reference SUVs. The SUV ratio was defined as the ratio of the SUVmax of the primary tumor and the SUVliver. RESULTS: The most common malignancy was SNAC (32%), followed by SNUC (24%), ONB (14%), ACC (10%), SMM (10%), and SNEC (10%). The SUVmax and SUV ratio values were significantly different between tumor types (p = 0.002 and 0.012, respectively). SNUC had the highest mean SUVmax (14.2), followed by SNAC (9.9). A similar mean SUVmax was observed for SMM, ONB, and ACC (∼ 7.0). SNEC up-takes the least 18FDG among these six tumor types (mean SUVmax = 4.7).

Evaluation of residual symptoms: A method to assess surgical outcomes for nasal polyposis.

BACKGROUND: The assessment of residual symptoms after endoscopic sinus surgery for nasal polyposis (NP) could be an accurate way to evaluate surgical outcomes. OBJECTIVE: To assess the residual symptoms and their severity at 6 weeks and 7 months after radical ethmoidectomy for NP. METHODS: Sixty-five patients who had surgery for NP were included in this prospective study. Six residual symptoms (nasal obstruction, anterior rhinorrhea, postnasal discharge, olfactory disturbances, facial pain, and cough) were assessed by using the validated Dysfonctionnement Nasal Chronique (French) or Chronic Nasal Dysfunction (English) questionnaire at 6 weeks and 7 months after surgery. Olfactory measurements were performed with the Sniffin' Stick test. A self-rating score of ≥1 was considered as "having a complaint." RESULTS: Radical ethmoidectomy for NP improved not only the number of symptoms but also the intensity of symptoms. Before surgery, 64 of 65 patients (98.46%) reported at least three of the six symptoms, whereas 26 patients (40%) reported six symptoms, 16 (24.62%) reported five symptoms, and 14 (21.54%) reported four symptoms. At 6 weeks and at 7 months after surgery, one-third of the patients had fewer than three symptoms. Olfactory disturbance remained the most mentioned postoperative disabling problem. Posterior discharge tended to become more pronounced at 7 months than at 6 weeks after surgery but remained considerably improved compared with the preoperative state. CONCLUSION: This information is useful to warn patients about the difficulty of getting rid of all symptoms and that there is a chance that some symptoms remain or even reappear after NP surgery.

Facial pain/headache before and after surgery in patients with nasal polyposis.

CONCLUSION: Endoscopic surgery improved facial pain/headache and physical-psychosocial impacts in patients with nasal polyposis. However, one fifth of patients still experienced residual pain after surgery, requiring neurologic counseling to look for the non-sinonasal cause of their symptoms. OBJECTIVE: Considering the limited amount of literature on facial pain/headache in patients with nasal polyposis, this prospective study assesses facial pain/headache and its impacts on the quality-of-life (QoL) before and after endoscopic surgery. METHODS: Facial pain/headache was assessed, using the DyNaChron questionnaire, in 107 patients with nasal polyposis 1 day prior to surgery and 6 weeks after surgery. All patients were operated on endoscopically on the bilateral ethmoidal labyrinths and olfactory clefts. RESULTS: Moderate or severe facial pain/headache was reported by 50% of the patients before surgery and by 20% after surgery. Post-operatively, 79.44% of patients reported no/very mild pain (vs 47.66% pre-operatively) and 20.56% moderate/severe pain (vs 52.33% pre-operatively). The pain was statistically reduced after surgery among patients with previous surgery (p = 0.0006). The scores of all analysed impacts of pain improved after surgery. However, patients with grade 1 polyps seemed to have less benefit from the surgery for facial pain/headache than those with more severe nasal polyposis.

Can surgeons predict the olfactory outcomes after endoscopic surgery for nasal polyposis?

OBJECTIVES/HYPOTHESIS: The aim of this study is to identify predictors for olfactory outcomes in patients with nasal polyposis (NP) after surgery on the ethmoidal labyrinths, either with or without resection of the polyps of the olfactory cleft (OC). STUDY DESIGN: Prospective study. METHODS: Ninety-six patients endoscopically operated on for NP were enrolled in this study. Olfactory measurements were performed 1 day prior to surgery and 6 weeks after surgery, using odor thresholds and identification tests of the Sniffin' Sticks kit and a 0- to 10-point visual analog scale. The multivariate logistic regression model was also used to assess independent predictors for olfactory outcomes after surgery. RESULTS: Twenty-seven patients with preoperative normosmia demonstrated normal olfactory function 6 weeks after surgery. Out of 69 patients with preoperative hypo-anosmia, 33 patients (47.83%) improved their olfactory function after surgery on the basis of the Sniffin' Sticks results. History of previous sinus surgery was reported by 77.78% of patients without olfactory improvement and by 51.52% with olfactory improvement (P = .022). By multivariate analysis, history of previous sinus surgery for NP remained a strong predictor of poor olfactory outcomes after surgery (adjusted odds ratio = 4.14, 95% confidence interval: 1.29-13.32, P = .017). Histopathological types of lesions inside the OC as well as the resection of moderate/big lesions in the OC were not predictors of olfactory outcomes. CONCLUSIONS: The more previous sinus surgeries, the smaller the chance for patients to recover their olfactory function after each surgical revision.