Preoperative Prediction of Sinonasal Inverted Papilloma‐associated Squamous Cell Carcinoma (IP‐SCC)

Abstract

IntroductionSinonasal inverted papillomas (IP) can undergo transformation into IP‐squamous cell carcinomas (IP‐SCC). More aggressive treatment plan should be established when IP‐SCC is suspected. Nevertheless, inaccuracy of the preoperative punch biopsy results to detect IP‐SCC from IP raises the need for an additional strategy. The present study aimed to investigate significant clinicoradiological remarks associated with IP‐SCC than IP.Material and MethodsPostoperative surgical specimens obtained from patients with confirmed IP or IP‐SCC at a single tertiary medical center from 1997 to 2018 were retrospectively evaluated. Patients' demographic and clinical characteristics, preoperative in‐office punch biopsy results, and preoperative computed tomography (CT) or magnetic resonance images were reviewed. Univariate and multivariate analyses were performed to assess the odds ratio (OR) associated with IP‐SCC. The area under the curve (AUC) in the receiver Operating Characteristic (ROC) curve was calculated in the prediction model to discriminate IP‐SCC from IP.ResultsThe study included 44 IP‐SCC and 301 patients with IP. The diagnostic sensitivity of in‐office punch biopsy to detect IP‐SCC was 70.7%. Multivariate analysis showed that factors significantly associated with IP‐SCC included tobacco smoking >10PY (adjusted‐OR [aOR]: 4.1), epistaxis (aOR: 3.4), facial pain (aOR: 4.2), bony destruction (aOR: 37.6), bony remodeling (aOR: 36.3), and invasion of adjacent structures (aOR: 31.6) (all p < 0.05). Combining all significantly related clinicoradiological features, the ability to discriminate IP‐SCC from IP reached an AUC of 0.974.ConclusionIP patients with a history of tobacco smoking, facial pain, epistaxis, and bony destruction, remodeling, or invasion of an adjacent structure on preoperative images may be at higher risk for IP‐SCC.Level of Evidence3 Laryngoscope, 133:2502–2510, 2023