Chen C M, Tsai Y L, Chang C C, Chen H C, Chen M K
Department of Otorhinolaryngology, Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan.
B-ENT. 2009;5(4):225-31.
To evaluate which clinical characteristics of inverted papilloma (IP) can result easily in misdiagnosis by clinicians and to determine the recurrence rate of inverted papilloma depending on diagnosis confirmation pre-operatively, intra-operatively or post-operatively.
Fifty-one patients were treated for IP and 47 patients attended regular post-operative follow-up appointments for at least one year (mean: 54 months).
The patients were assigned to 3 groups: group Ia, in which IP was not confirmed until the post-operative pathology findings; group Ib, in which IP was confirmed during the operation; and group II, in which IP was confirmed before the operation. There were nineteen (37%) patients in group Ia, nine patients (18%) in group Ib and twenty-three patients (45%) in group II. The recurrence rates for groups Ia, Ib and II were 33%, 11% and 5% respectively.
The initial presentation of bilateral sinonasal disease can easily lead the doctor into the misdiagnosis of IP. Bony erosion, remodelling, and a widening of the natural orifice of the sinuses on a CT scan are useful signs indicating IP. The correct diagnosis prior to surgery is a determinant of outcome. The use of frozen sections should, however, improve outcome as well. In this study we highlight the high prevalence and relatively low control rate of misdiagnosed IP (pathology undetermined pre-operatively) and hope to remind clinicians that early recognition of the tumour is most beneficial to patients.
评估内翻性乳头状瘤（IP）的哪些临床特征容易导致临床医生误诊，并根据术前、术中或术后确诊情况确定内翻性乳头状瘤的复发率。
51例患者接受了IP治疗，47例患者定期进行了至少一年的术后随访（平均：54个月）。
患者被分为3组：Ia组，术后病理结果才确诊为IP；Ib组，术中确诊为IP；II组，术前确诊为IP。Ia组有19例（37%）患者，Ib组有9例（18%）患者，II组有23例（45%）患者。Ia组、Ib组和II组的复发率分别为33%、11%和5%。
双侧鼻窦疾病的初始表现容易导致医生对内翻性乳头状瘤误诊。CT扫描显示的骨质侵蚀、重塑以及鼻窦自然开口增宽是提示内翻性乳头状瘤的有用征象。术前正确诊断是预后的决定因素。然而，使用冰冻切片也应能改善预后。在本研究中，我们强调了误诊的内翻性乳头状瘤（术前病理未确定）的高发生率和相对较低的控制率，并希望提醒临床医生早期识别肿瘤对患者最为有利。
