Is Computed Tomography Scan More Sensitive than Histopathology in Detecting Sinonasal Tumors?

The present study aimed to evaluate the accuracy of computed tomography in the preoperative diagnosis of sinus masses at the Central Hospital of Yaoundé, Cameroon. Diagnostic and therapeutic tools that can orient the clinician prior to histopathology confirmation include rigid and flexible endoscopy, as well as imaging techniques such as computerized tomography (CT) scan and magnetic resonance imaging (MRI). A diverse range of pathologies affect the sinonasal cavities, because of the nonspecific nature of the symptoms, most patients with sinonasal masses are diagnosed late when the disease is at an advanced stage. The diagnostic challenge of identifying the nature of sinonasal masses before treatment would guide therapeutic strategies. A retrospective chart review was conducted; CT scan reports and pathology reports of patients operated for sinonasal masses between January 2012 and November 2022 were compared.

Results: Forty-five patients met the inclusion criteria for the study. The average age was 39.98 ± 18.34 years, with extremes of 15 and 87 years. The sex ratio H/F is 0.76 with a female predominance. The median time to consultation was 14 [12 - 18] months, with extremes of 11 and 36 months. The most frequently encountered histological type was benign tumors with sinonasal polyposis (PNS) in the lead, i.e. 34.1% of cases. The types adenocarcinoma, adenoid cystic carcinoma and non-Hodgkin’s lymphoma were represented equally in 6.8% of cases. Management was dominated by Caldwell-Luc surgery, i.e. 59.1% of cases. The frequency of disease recurrence after surgical treatment was 18.2%. As for the mortality rate, it was 11.4%. The concordance rate of the character of malignancy on imaging compared to histology was 90.9%. This level of concordance was statistically significant according to the Gamma test (p < 0.001). The diagnostic performances of imaging in malignant tumors are: Sensitivity 88.9%, Specificity 92.3%, Positive Predictive Value 88.9%, Negative Predictive Value 92.3%. This study found that computed tomography can diagnose both benign and malignant sinonasal masses, but there are some false positives, particularly in the case of the histological type Inverted Papilloma.

Conclusion: Preoperative CT scans correlate with histology and have a predictive value in surgically treated sinonasal tumors. MRI with the measurement of the diffusion coefficient, and MRI spectroscopy have demonstrated promising results in terms of differentiation between malignant and benign tumors and seems to be an area of future research in the diagnosis of nasosinus masses. The CT/MRI couple could be essential to provide relevant information for the surgeon.