1. Tumor recurrence with inverted papilloma is more likely if the initial tumor involves the carotid artery or optic nerve or is identified as carcinoma in situ.
2. Sphenoid sinus inverted papilloma is associated with a 14.6% rate of recurrence after surgery and age is associated with a decrease in the rate of recurrence.
Evidence Rating Level: 3 (Average)
Study Rundown: Inverted papilloma (IP) is one of the most common benign tumors of the nasal cavity and paranasal sinuses. Surgery is the first-line treatment for IP due to an increased risk of malignancy if left untreated. IP originating from the sphenoid sinus is often challenging to completely remove due its proximity to vital structures, which potentially increases the risk of tumor recurrence and malignant transformation. In this study, the authors evaluated clinical risk factors for sphenoid sinus IP recurrence that could be used to improve the current management paradigm. They found that sphenoid sinus IP was associated with a 14.6% rate of recurrence after surgery. Importantly, they demonstrated that IP involving the carotid artery or optic nerve, or with dysplasia or carcinoma in situ (CIS) were associated with a higher risk of recurrence. Though this study’s sample size is the largest to date, it still remains small enough to limit generalizability. Although the rate of recurrence for sphenoid sinus IP has been reported previously, this is the first study to evaluate clinical risk factors for tumor recurrence.
In-Depth [case-control study]: This retrospective study involving 48 patients from 7 academic institutions across North America, included patients who underwent endoscopic resection of sphenoid sinus IP during 1996 to 2014. Median follow-up period was 14 months and none of the patients developed a malignancy during this study period. Potential risk factors for tumor recurrence were assessed using the bivariate analyses of the Anderson and Gill Cox model. In this study, the authors found that IP associated with the carotid artery or optic nerve had a 4.76 times greater likelihood of recurrence compared to other tumor sites (RR=4.76; p=0.073). In addition, they found that IP associated with dysplasia or CIS had a 3.6 times greater rate of recurrence (RR=3.6; p=0.08) while older age was associated with lower rate of recurrence (RR=0.95; p=0.063).
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