xRead - Nasal Obstruction (September 2024) Full Articles

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KUANetal.

Role of endoscopy for surveillance

Intervention Posttreatment imaging should be performed to detect residual or recurrent disease. MRI and/or FDG-PET/CT should be the modality of choice. Multiple scans provide for

Aggregate grade of evidence

C (Level 3: two studies; level 4: one study).

adequate comparison of changes across time. The timing is left to provider discretion, but FDG-PET/CT should be performed 12 weeks following completion of treatment, and MRI should be performed within 8–10 weeks following treatment.

Benefit

Detection of a primary tumor recurrence, assess extent of involvement, and evaluation for feasibility of resection. Risk of local tissue trauma and potential to miss recurrence deep to mucosa. Direct costs: procedure fees and consultation fees. Preponderance of benefits over harms. Direct visualization of the paranasal sinuses with rigid or flexible endoscopes should be performed, especially for postsurgical patients.

Harm

Cost

Differences in surveillance practices based on histology

Benefits–harm assessment

Aggregate grade of evidence

D (no dedicated studies)

Value

judgments

Benefit

Detection of recurrent or residual sinonasal tumors. Missing late or early recurrence of disease; unnecessary testing or examinations.

Harm

Policy level Recommendation. Intervention Nasal endoscopy should be performed at each

Cost

None.

surveillance visit to assess for local tumor recurrence within the sinonasal tract, as well as to assess mucosal health and side effects (e.g., crusting).

Benefits–harm assessment

Insufficient evidence.

Value

Sinonasal tumors behave differently from other head and neck tumors. Surveillance should be tailored to specific tumor histology and biologic behavior.

judgments

Role of imaging for surveillance

Policy level No recommendation. Intervention Tumor histology should be taken into consideration when determining the appropriate surveillance protocols. Most tumors recur within the first 5 years;

Aggregate grade of evidence

C (Level 3: seven studies; level 4: one study).

Benefit

Detection of recurrent disease that cannot be detected though physical exam or nasal endoscopy (e.g., lateral frontal sinus, submucosal, intracranial, intraorbital). Minimal harm of radiation and allergic reaction from radioisotopes. Potential for unnecessary testing leading to financial consequences. Direct costs: variable cost depending on institution and imaging protocols. Preponderance of benefits over harms. FDG-PET/CT should be used for evaluation of regional or distant metastases, while MRI is the treatment of choice for surveillance of the primary site (i.e., superior soft tissue definition). CT can be considered but has less sensitivity compared to MRI.

however, certain pathologies (e.g., IP, ONB) have propensity for recurrence greater than 10 years following definitive treatment.

Harm

Figure I.1 provides a sample diagnosis through man agement through survivorship paradigm based on ICSNT findings.

Cost

Benefits–harm assessment

D Discussion Oncologic care is highly individualized, and while guide lines may not always be practical, it is crucial to utilize evidence-based medicine to inform patient care. The ICSNT aims to address this need and bridge the gap. Given the relative rarity of sinonasal tumors, the LOE available for most topics remains low, primarily consisting of aggre gate grade C evidence derived from observational studies

Value

judgments

Policy level

Recommendation.

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