Toward a Uniform Reporting of Surgical Specimens with a Diagnosis of Fungal Rhinosinusitis
Erin M Linde, Geoffrey A Talmon, Steven H Hinrichs, Peter C Iwen. University of Nebraska Medical Center, Omaha, NE
Background: Fungal rhinosinusitis (FRS) represents 5-12% of rhinosinusitis cases and is broadly categorized as invasive (acute [AIFRS], granulomatous, and chronic) and non-invasive (fungus ball [FB] and eosinophilic to include allergic [AFRS]) disease. Each classification has a distinct clinicopathologic picture and recommended therapy. Multiple studies on FRS have concentrated on disease categorization; however, standardization of reporting has not been described. This study evaluates surgical pathology reports of FRS and provides a template for standardized reporting.
Design: A retrospective review of surgical pathology reports from January 2007 through May 2011 was done to identify all FRS cases. These reports were examined for information on disease classification, fungal elements present, presence/absence of tissue invasion, and etiological agent class/genus. Slides for each case were blindly reviewed and culture data was correlated with the tissue findings.
Results: Seventy-one FRS cases were identified with the initial classifications as unclassified (47.9%), fungus ball (19.7%), AIFRS (15.5%), AFRS (9.9%), and other including chronic sinusitis and allergic mucinous sinusitis (7%). The presence/absence of invasion was specified for each diagnosis as listed: AIFRS (100%), fungus ball (64.3%), other (40%), unclassified (29.4%), and AFRS (14.2%). The percentages where a possible etiological agent class/genus was reported for AIFRS, fungus ball, AFRS, and unclassified were 54.5%, 50.0%, 14.2%, and 23.5%, respectively. Of the 67 cases reviewed, 42 (62.3%) were reclassified based on published criteria as fungus ball (46.2%), AFRS (23.9%), AIFRS (22.3%), and unclassified (7.5%). For all cases, only 31% gave a probable etiological agent class/genus with 13.6% of these culture positive that correlated 66.6% of the time with the histology findings. Only 9.9% of the reports included all four reporting features.
Conclusions: According to published criteria the reporting of pertinent tissue findings in FRS should include disease categorization, description of hyphal elements, presence or absence of tissue invasion, and a probable etiological agent. The results of this study showed that most cases did not use this format and were not properly classified. This highlights a need for a standardized reporting method to help in the management of patients with FRS.
Wednesday, March 21, 2012 1:00 PM
Poster Session VI # 259, Wednesday Afternoon