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A prospective analysis evaluating tissue biopsy location and its clinical relevance in chronic rhinosinusitis with nasal polyps
Author(s) -
Weibman Ava R.,
Huang Julia He,
Stevens Whitney W.,
Suh Lydia A.,
Price Caroline P.E.,
Lidder Alcina K.,
Conley David B.,
Welch Kevin C.,
ShintaniSmith Stephanie,
Peters Anju T.,
Grammer Leslie C.,
Kato Atsushi,
Kern Robert C.,
Schleimer Robert P.,
Tan Bruce K.
Publication year - 2017
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.22005
Subject(s) - medicine , nasal polyps , eosinophilia , gastroenterology , asthma , hazard ratio , eosinophil , sinusitis , proportional hazards model , surgery , confidence interval
Background Chronic rhinosinusitis with nasal polyps (CRSwNP) has a high propensity for recurrence. Studies suggest that eosinophilia influences disease severity and surgical outcomes, but the selection of sinonasal site for measuring eosinophilia has not been examined. The aim of this study was to investigate how region‐specific tissue eosinophilia affects radiographic severity, comorbidity prevalence, and polyp recurrence risk following sinus surgery. Methods Eosinophil cationic protein (ECP) levels in uncinate tissue (UT) and nasal polyp (NP) homogenates from 116 CRSwNP patients were measured using enzyme‐linked immunosorbent assay (ELISA). Clinical history, radiographic severity, and time to polyp recurrence were obtained from electronic health records. The correlations between baseline Lund‐Mackay scores and comorbidities were compared between UT and NP ECP levels. Cox regression and Kaplan‐Meier analysis were then performed to assess whether UT or NP ECP better predicted recurrence. Censoring occurred at 4 years or at last follow‐up if there was no endoscopic diagnosis of recurrent polyps. Results Lund‐Mackay scores were significantly correlated with UT and NP ECP ( r = 0.46 and 0.26 respectively, p < 0.05). UT but not NP ECP was significantly higher in patients with asthma ( p < 0.01) and aspirin‐exacerbated respiratory disease (AERD) ( p < 0.05). Polyp recurrence risk was only significantly higher for patients with eosinophilic UT tissue (hazard ratio [HR] = 2.84, p = 0.025). When measured in NP, eosinophilia did not predict recurrence. Conclusion Although ECP in NP was higher than in UT tissue, eosinophilia in UT tissue was a more clinically coherent biomarker of baseline radiographic severity, comorbid asthma and AERD, and prospective polyp recurrence risk than NP eosinophilia.