Diagnostic reliability of pretreatment biopsy in malignant nasoethmoidal tumors: A retrospective study of 77 cases

Objectives/Hypothesis

Pretreatment biopsy is crucial in histology-based management of malignant nasoethmoidal tumors, because misdiagnosis can lead to inadequate therapeutic planning. Factors influencing the reliability of biopsy were retrospectively investigated in a tertiary referral center.

Study Design

Retrospective case series.

Methods

All patients who underwent biopsy, staging magnetic resonance, surgery, and histologic diagnosis for nasoethmoidal tumors in our hospital were retrospectively evaluated. Histologic discrepancy, histology, procedure for biopsy (biopsy under local anesthesia [OB], biopsy under local anesthesia and sedation [SB], or under general anesthesia [GB]), site of the lesion, and the biopsy volume were analyzed. Biopsy reliability rate (BRR) (preoperative biopsy confirmed after surgical treatment) and concordance rate (CR) (postoperative diagnosis identified in preoperative biopsy) were calculated. Univariate and multivariate statistical analyses were used to identify factors influencing histologic discrepancies.

Results

Seventy-seven patients were included. Five (6.5%) minor and eight (10.4%) major histologic discrepancies were observed (16.9%). OB and SB showed significantly lower biopsy volumes than GB (P < .0001 and P = .002, respectively). The biopsy volume was significantly lower in cases with histologic discrepancies (P = .045). Squamous cell carcinoma was independently associated with lower BRR. Germ cell tumor, salivary gland carcinoma, and sarcoma showed the lowest CR. Adenocarcinoma, mucosal melanoma, and olfactory neuroblastoma showed the highest BRR and CR.

Conclusions

The risk of misdiagnosis for nasoethmoidal tumors may be high even in referral centers. Especially when clinical and radiologic findings suggest a diagnosis different from adenocarcinoma, mucosal melanoma, and olfactory neuroblastoma, obtaining abundant material under general anesthesia may reduce the risk of diagnostic error and inadequate treatment.

Level of Evidence

4. Laryngoscope, 2018

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