Comparative Histopathological and CT Analysis of Sinonasal Lesions in Chronic Rhinosinusitis Patients

Abstract

Background: Chronic rhinosinusitis (CRS) is a common sinonasal disorder characterized by prolonged inflammation of the nasal and paranasal sinus mucosa, significantly affecting patients’ quality of life. Accurate diagnosis of sinonasal lesions associated with CRS is critical for appropriate treatment, with computed tomography (CT) and histopathological analysis being the primary diagnostic tools. However, the comparative effectiveness of these modalities remains underexplored. Objective: This study aimed to compare the diagnostic accuracy of CT imaging and histopathological analysis in identifying sinonasal lesions in CRS patients, and to evaluate their complementary roles in diagnosis. Study Design and Setting: A prospective, observational study was conducted at Department of ENT, Head and Neck Surgery, Shaikh Zayed Hospital Lahore involving 130 CRS patients who were scheduled for surgical intervention. Methodology: Patients underwent high-resolution CT scans followed by functional endoscopic sinus surgery (FESS) where tissue samples were collected for histopathological examination. CT findings were analyzed using the Lund-Mackay scoring system, while histopathological features, including inflammatory cells, polyps, fibrosis, and infection, were assessed. The sensitivity, specificity, and diagnostic accuracy of both methods were calculated and compared. Results: CT imaging demonstrated a sensitivity of 87.4% and a specificity of 78.3%, while histopathology had a sensitivity of 92.3% and a specificity of 82.5%. The overall diagnostic accuracy of histopathology (90.2%) was higher than CT (83.1%), with both modalities showing high concordance in CRS with nasal polyps (CRSwNP). Conclusion: Histopathology offers superior diagnostic accuracy over CT for identifying sinonasal lesions in CRS patients. The combined use of both modalities can enhance diagnostic precision and guide more effective treatment strategies.