Prampart A1*, Djennaoui I1, Ciftci S1, Riehm S2 and Debry C1
1Department of Otorhinolaryngology (ENT) and Head and Neck Surgery, Strasbourg University Hospital, CHRU Hautepierre, 1 Avenue Molière 67100 Strasbourg, France
2Department of Radiology, Strasbourg University Hospital, CHRU Hautepierre, 1 Avenue Molière 67100 Strasbourg, France
Received: 28 April, 2017; Accepted: 27 May, 2017; Published: 29 May, 2017
Alexandre Prampart, Service ORL & Chirurgie cervico-faciale, Hôpitaux Universitaires de Strasbourg, CHRU Hautepierre, 1 Avenue Molière 67100 Strasbourg, France, E-mail:
Prampart A, Djennaoui I, Ciftci S, Riehm S, Debry C (2017) Postoperative Correlation of Radiological and Surgical Findings in Management of Ethmoid Sinus Adenocarcinoma. Arch Otolaryngol Rhinol 3(2): 051-55. DOI: 10.17352/2455-1759.000045
© 2017 Prampart A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Adenocarcinoma; Ethmoid; MRI; Monitoring; Recurrence
Aims:Prognosis of ethmoid sinus adenocarcinoma (ADK) is essentially determined by local tumor control. There is a high rate of recurrence of these tumors across the range of patient series. Development of an optimal follow-up protocol of such tumors is recommended.
Patients and methods:A retrospective, monocentric study was carried out including all patients diagnosed with ADK who underwent surgery and were followed up at our center between 2012 and 2016 and who were monitored postoperatively using magnetic resonance imaging (MRI) and histopathological verification of suspicious areas identified via imaging. Time to postoperative MRI, time to recurrence and sites of recurrence were obtained for each patient.
Objectives:Performance evaluation of MRI in early screening of recurrence or residualtumors postoperatively in the management of ADK and identification of the main sites prone to risk of recurrence in these tumors.
Results:We included 24 cases of ADK, there were 33% cases of recurrence with a mean time to recurrence of 35 months postoperatively. Mean time to completion of the first MRI scan was 65 days postoperatively.
Performance parameters of screening for recurrence or residual tumors on the first postoperative MRI were:
Se 64%; Sp 78%; PPV 69%; NPV 74%.
Conclusions: Efficacy of postoperative MRI screening appears to be limited and regular endoscopic monitoring associated with imaging is required. Sites prone to risk should be subject to particular consideration in primary surgical resection and management of recurrence.
The benefit of imaging in the immediate postoperative period has yet to be assessed in terms of disease-free survival and disease control.
Paranasal sinus and nasal fossa cancers are rare tumors which are found most commonly in the ethmoid sinuses (5 % - 30%) [1,2]. Adenocarcinoma of the ethmoid sinus (ADK) is the prevailing histological type and originates in the olfactory cleft [1-4]. Prognosis of this type of neoplasia is essentially determined by initial local control of the disease.
Current optimal treatment of ethmoid sinus tumors is based on an association of complete surgical resection and adjuvant radiotherapy [5-10].
Despite recent innovations in such treatment (quality of endoscopic optics, endonasal instrumentation, intensity-modulated conformal radiotherapy…) clinical evolution nevertheless demonstrates a high rate of locoregional recurrence (30% of cases on average) involving complications principally due to complex anatomy and proximity to important anatomic structures [11-13].
Tumors are predominantly monitored using magnetic resonance imaging (MRI) and endoscopic examination under local anesthetic by appointment and/or general anesthetic involving biopsy in the event of the slightest doubt.
This study aims i) to evaluate the benefit of the first postoperative MRI in detecting tumor recurrence ii) to determine its benefit in surgical management of recurrence iii) to identify the main sites prone to risk of recurrence.
Patients and Methods
We carried out a retrospective monocentric study on 24 patients (n=24) treated in our center for primitive ADK during the period from 2012 to 2016. Inclusion criteria comprised all cases of initial or recurrent primitive ADK having undergone surgical resection followed by MRI monitoring (indifferently 1,5 or 3 Tesla, depending on the availability of the devices on the date of follow-up) and histological confirmation of suspicious areas detected on imaging.
i) all primitive ethmoid sinus tumors which were not adenocarcinomas
ii) tumors which did not receive postoperative MRI monitoring.For each patient we recorded the gender, age, incidence of occupational exposure to risk, initial loco-regional extension of the tumor shown on imaging, initial evidence of lymphadenopathy, TNM stage, initial treatment, selection of surgical approach (endonasal or external), presence of treatment adjuvant to surgery, delivered dose and delivery duration involving external radiotherapy, type of chemotherapy, period of time before completion of postoperative MRI, incidence of recurrence including site of recurrence and time to recurrence, treatment of recurrence, follow-up time in relation to initial treatment.
All of the MRI scans were assessed by a single experienced radiologist who was blind to subject status and specialised in ENT and facial bone imaging.
Radiological interpretation was compared with anatomopathological results of biopsies performed in suspicious areas, thus determining statistical measures of sensitivity (Se), specificity (Sp), negative predictive value (NPV) and positive predictive value (PPV).
Study population [Table 1]
We included ADK (n=24), only men, diagnosed at an advanced stage (37.5% with T4; n=9/24) and initially treated with endonasal endoscopy (75%; n=18/24). Mean follow-up was 38 months.
The first postoperative follow-up MRI scan was performed at a mean of 65 days after surgical resection (median 50 days) with a progressive decrease in interval length over a period of years [Figure 1].
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