Juvenile Nasal Angiofibromas: A Comparison of Modern Staging Systems in an Endoscopic Era

    loading  Checking for direct PDF access through Ovid

Abstract

Objectives

To compare the clinical utility of four juvenile nasal angiofibroma (JNA) staging systems in a large cohort of patients.

Design

Retrospective case series.

Setting

Tertiary referral academic center.

Participants

Pediatric patients undergoing surgical resection of JNAs between January 2008 and June 2015.

Main Outcome Measures

Intraoperative blood loss and transfusions, number of staged operations, postoperative residual disease, and recurrent disease.

Results

In total, 34 patients were identified; all underwent preoperative embolization followed by surgery. Of the 34 patients, 33 (97%) underwent an exclusively endoscopic surgical approach, with 6 (18%) requiring planned staged operations. Ten (29%) patients had residual disease and three (9%) required further surgical resection. Using the area under the curve (AUC) of receiver operating characteristic curves, the University of Pittsburgh Medical Center (UPMC) staging system was most predictive of patients who required staged procedures, received intraoperative transfusions, and had residual postoperative disease (AUC: 0.89, 0.88, 0.86, respectively).

Conclusions

The UPMC JNA staging system accounts for both route of skull base extension and tumor vascularity, which are two important tumor attributes in the age of preoperative embolization and endoscopic endonasal surgery. The UPMC staging system is a reliable modern staging system that closely reflects prognostic information and aids in surgical planning.

Related Topics

    loading  Loading Related Articles