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374

KUANetal.

TABLE XXXIII.3 Evidence surrounding the use of imaging in the surveillance of sinonasal tumors.

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusions

Thakar et al. 2203

PSMA-PET/CT had higher PPV and specificity comparted to MRI

2020 3

Prospective cohort

18 patients with JNA Diagnostic utility ofMRI and PSMA PET/CT

Workman et al. 421

2017 3

Retrospective cohort

78 patients with SNM who underwent treatment and had

Diagnostic utility of FDG-PET/CT

FDG-PET/CT can detect treatable recurrences that can be missed with structural imaging with high sensitivity and NPV The posttreatment sinonasal skull base is characterized by prolonged periods of hypermetabolism, which affects FDG-PET/CT accuracy FDG-PET/CT has low PPV for detection of primary site recurrence FDG-PET/CT is highly sensitive; however, posttreatment mucosal inflammation may alter the accuracy FDG-PET/CT is highly sensitive and specific for the detection of recurrence in the maxillary sinus

posttreatment FDG-PET/CT 76 patients with

DFS, recurrence rates, diagnostic utilityof FDG-PET/CT

Schwartz

2016 3

Retrospective cohort

et al. 2193

nonlocally recurrent SNMwho underwent FDG-PET/CT

Lamarre et al. 197 2012 3

Retrospective cohort

31 patients with SNM Diagnostic utility of FDG-PET/CT 34 patients with SNM Diagnostic utility of FDG-PET/CT

Harvey et al. 420

2010 3

Retrospective cohort

Rhoet al. 2204

2010 3

Retrospective cohort

22 patients with

Diagnostic utility of FDG-PET/CT

maxillary sinus cancerwho underwent FDG-PET/CT

Gil et al. 216

Postoperative follow-up using PET/CT enables early detection of tumor recurrence and guides endoscopic biopsies

2007 3

Prospective cohort

47 patients with skull base tumors

Diagnostic utility of FDG-PET/CT Diagnostic utility of FDG-PET/CT

Khalili et al. 418

2016 4

Retrospective case series

109 patients with

1. Imaging is superior to endoscopy in terms of

primary SNM who underwent successful definitive treatment

sensitivity, accuracy, and NPV 2. MRI more reliably predicts sinonasal cancer recurrence than either FDG-PET/CT or CT alone

Abbreviations: 18 F-FDG, fluorodeoxyglucose F 18; CT, computed tomography; DFS, disease-free survival; JNA, nasopharyngeal angiofibroma (formerly juvenile nasopharyngeal angiofibroma); OS, overall survival; PET, positron emission tomography; PSMA, prostate-specific membrane antigen; SNM, sinonasal malignancy.

XXXIV RESEARCH OPPORTUNITIES AND FUTURE DIRECTIONS Despite the rarity and heterogeneity of sinonasal tumors, the interest in investigating pathophysiology, diagno sis, treatment, and prognostication is increasing rapidly. While the literature has historically classified sinonasal tumors by anatomical subsite, there is increasing focus on histopathology in studying and classifying each tumor type. The current literature on specific histopathologies primarily relies on retrospective case series and retro-

ocal in 40% of cases and nasal endoscopy only visualized 50% of tumors. Multiple factors appeared to influence rates of recurrence and surveillance decisions. Nakayama et al. used annual CT or MRI for surveillance when the tumor attachment point was not identified intraoperatively. 2194 Similarly, Jiang et al. used posttreatment CT for surveil lance when the primary site was difficult to visualize on postoperative nasal endoscopy. 2199 Furthermore, attach ment in the frontal sinus or to the opticocarotid recess in sphenoid sinus IP showed increased risk for recurrence, necessitating closer follow-up. 369,720,1135