xRead - Nasal Obstruction (September 2024) Full Articles

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ICAR SINONASAL TUMORS

was determined using the American Academy of Pediatrics Steering Committee on Quality Improvement and Man agement (AAP SCQIM) guidelines. 9 Each topic underwent iterative review by at least two members of the edito rial team, as well as the primary and senior editors, to ensure completeness of the literature and appropriateness of the recommendations. The compiled topics were then synthesized and distributed for review by all authors for consensus, resulting in the ICSNT document. C Results Section 1: General principles Incidence and epidemiology Among benign sinonasal tumors, osteomas are the most common, followed by sinonasal papillomas. Sinonasal malignancy (SNM) comprises approximately 3%–5% of all head and neck cancers and < 1% of all malig nancies overall. The estimated incidence of SNM in the United States is < 1 case per 100,000 population per year. Malignant epithelial neoplasms account for 75% of all SNM, with the most common being squamous cell carci noma (SCC), followed by adenocarcinoma, olfactory neu roblastoma (esthesioneuroblastoma) (ONB), and adenoid cystic carcinoma (ACC). General risk factors There are various well-established risk factors for devel opment of both benign and malignant sinonasal tumors. Careful history taking and ordering appropriate genetic and molecular tests, whenever applicable, may provide insights for patient counseling and treatment planning. Assessment of risk factors for sinonasal tumors

Harm

Recall bias of risk factors, variable risk of tumorigenesis across different individuals and populations. No studies assessing cost, but likely low costs of screening by history. Molecular testing may be costly. Preponderance of benefits over harms. Many risk factors are nonmodifiable. There is a need for further research into the role of molecular and genomic testing.

Cost

Benefits–harm assessment

Value

judgments

Policy level Recommendation. Intervention Routine history taking and screening for risk factors such as age, sex, ethnicity, occupational exposure, and smoking may provide clinically useful prognostic

information and prevention opportunities. Testing for genetic and viral etiologies may be considered, especially if there are actionable mutations.

Principles of surgical treatment Common oncologic principles apply in surgical treatment of sinonasal tumors. Traditionally, en bloc resection of the entire tumor with negative margins, often via an open approach, comprised the standard of care, but this is chal lenging to perform within the confines of the sinonasal tract, especially without confirmation of tumor invasion versus abutment of structures. Consideration should be given to preserving quality of life (QOL) and critical neu rovascular structures if oncologically possible. To that end, in lieu of an open approach, an alternative is endoscopic piecemeal resection and debulking of the tumor with definitive en bloc resection of the sites of attachment and assessing margins thereafter. The risk of tumor seeding is low overall. En bloc versus debulking/piecemeal resection

Aggregate grade of evidence

C for all risk factors ∙ Level 4: eight studies (age) ∙ Level 3: two studies; Level 4: seven studies (genetic sex) ∙ Level 2: one study; Level 3: five studies; Level 4: four studies (occupational exposure) ∙ Level 3: three studies (smoking) ∙ Level 2: two studies; Level 3: one study; Level 4: one study (link to viral infections) ∙ Level 3: two studies; Level 4: nine studies (genetic factors) Understanding and screening of risk factors for tumorigenesis provide prognostic information and opportunities for prevention. (Continued)

Aggregate grade of evidence

C (Level 3: seven studies; Level 4: two studies)

Benefit

Piecemeal resection has the benefit of improved visualization of the tumor attachment site and determining invasion into surrounding structures. En bloc resection, whenever possible, permits gross visualization of clear margins around the resection Piecemeal resection has the theoretical risk of tumor seeding in the cavity via violation of the tumor capsule. En bloc resection is potentially invasive and disfiguring.

Harm

Benefit

(Continued)