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Background <p>Unilateral sinonasal masses pose a diagnostic challenge due to overlapping clinical and radiological features between benign and malignant lesions. Accurate preoperative diagnosis is critical, as a significant proportion of apparently benign lesions may harbor malignancy. An integrated diagnostic approach combining clinical evaluation, imaging, endoscopy, biopsy, and histopathology with immunohistochemistry (IHC) is essential for optimal management.</p> Objectives <p>To analyze the clinicodemographic profile of patients with unilateral sinonasal masses, correlate clinical and radiological findings with final histopathological diagnosis, and assess the diagnostic concordance and predictive performance of endoscopic biopsy, with particular emphasis on the role of IHC in challenging cases.Methods: This retrospective observational study was conducted at a tertiary care center over 42 months (January 2022–June 2025). Eighty-four patients aged ≥6 years with unilateral sinonasal masses and complete clinical, radiological, and histopathological data were included. All patients underwent nasal endoscopy and CT imaging; MRI was performed selectively. Endoscopic biopsy was performed in non-vascular lesions. Diagnostic agreement between biopsy and final histopathology was assessed using Cohen’s kappa, and positive and negative predictive values (PPV, NPV) were calculated.</p> Results <p>The mean age was 45.2 ± 16.3 years, with male predominance (1.63:1). Benign lesions constituted 78.6%, while malignancies accounted for 21.4%. Nasal polyposis and inverted papilloma were the most common benign entities. Endoscopic biopsy showed substantial to almost perfect agreement with histopathology (κ = 0.767–0.926). Carcinoma demonstrated a PPV of 100% and NPV of 97.2%. IHC was required in 21.4% of cases and proved crucial in confirming rare and morphologically ambiguous malignancies.</p> Conclusion <p>A structured multimodality diagnostic approach yields high diagnostic concordance in unilateral sinonasal masses. Selective use of endoscopic biopsy and IHC is pivotal, particularly for excluding malignancy and accurately characterizing rare tumors in tertiary care settings.</p>

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Integrated Diagnostic Approach to Unilateral Sinonasal Masses: Clinicoradiological-Histopathological Correlation from a Tertiary Care Centre

  • 期刊论文

  • 发表日期：

    2026年7月25日

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  • Kamalpreet Singh,
  • S. Hari Kumar,
  • Sumanta Roy,
  • L. Prasanth,
  • Poonam Raj,
  • Amrindarjeet Kour

摘要

Background

Unilateral sinonasal masses pose a diagnostic challenge due to overlapping clinical and radiological features between benign and malignant lesions. Accurate preoperative diagnosis is critical, as a significant proportion of apparently benign lesions may harbor malignancy. An integrated diagnostic approach combining clinical evaluation, imaging, endoscopy, biopsy, and histopathology with immunohistochemistry (IHC) is essential for optimal management.

Objectives

To analyze the clinicodemographic profile of patients with unilateral sinonasal masses, correlate clinical and radiological findings with final histopathological diagnosis, and assess the diagnostic concordance and predictive performance of endoscopic biopsy, with particular emphasis on the role of IHC in challenging cases.Methods: This retrospective observational study was conducted at a tertiary care center over 42 months (January 2022–June 2025). Eighty-four patients aged ≥6 years with unilateral sinonasal masses and complete clinical, radiological, and histopathological data were included. All patients underwent nasal endoscopy and CT imaging; MRI was performed selectively. Endoscopic biopsy was performed in non-vascular lesions. Diagnostic agreement between biopsy and final histopathology was assessed using Cohen’s kappa, and positive and negative predictive values (PPV, NPV) were calculated.

Results

The mean age was 45.2 ± 16.3 years, with male predominance (1.63:1). Benign lesions constituted 78.6%, while malignancies accounted for 21.4%. Nasal polyposis and inverted papilloma were the most common benign entities. Endoscopic biopsy showed substantial to almost perfect agreement with histopathology (κ = 0.767–0.926). Carcinoma demonstrated a PPV of 100% and NPV of 97.2%. IHC was required in 21.4% of cases and proved crucial in confirming rare and morphologically ambiguous malignancies.

Conclusion

A structured multimodality diagnostic approach yields high diagnostic concordance in unilateral sinonasal masses. Selective use of endoscopic biopsy and IHC is pivotal, particularly for excluding malignancy and accurately characterizing rare tumors in tertiary care settings.