engleski

Can histological findings predict surgical outcome in patients operated for nasal polyps?

Nasal polyposis is known for its tendency to recur after operation. Clinical experience shows wide spectrum of outcomes: some patients are "cured" with one operation, while others require several operations due to rapid recurrence. The aim of this study was to determine whether IL-5, VEGF, IgE and eosinophile count in operated specimen can predict clinical outcome in operated patients. Thirty patients with nasal polyps have been included. Every patient had preoperative endoscopic and CT staging and subjective score (SS) questionnaire. Removed polyps have been analyzed histologically for eosinophile count and immunohistochemically (IHS) for IL-5, VEGF and IgE positivity. Patients have been followed up for one year, by nasal endoscopy and questionnaire. The patohistology and IHS score was correlated with clinical outcome. One year postoperatively 19 patients had no recurrence, 3 had miminal recurrence (Malm 1), 6 moderate (Malm 2) and 2 patients had gross recurrence (Malm 3). SS correlated with clinical score, so patients with no clinical recurrence had best SS (average 88% improvement) and patients with recurrent polyps had average SS improvement of 36%. When correlating patohistology and IHS score with clinical improvement, patients with higher IL-5, IgE, and eosinophil score had more reccurences and lesser SS improvement. VEGF did not show such a negative correlation with SS or clinical improvement. This study lead to several conclusions: 1. The applied SS questionnaire is valuable tool for assessment of postoperative improvement and nicely correlates with clinical endoscopic evaluation ; 2. Though not statistically significant, some histologic and IHS parameters could predict clinical outcome after surgical treatment ; 3. larger group of patients and different cut-off points for IHS scoring could improve predictive value of those scores.

nasal polyposis; histology; surgery; outcome

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