Sinonasal Masses: Clinical, Radiological, and Histopathological Correlation - A Retrospective Cohort Study from a Tertiary Care Center

Background: Sinonasal masses are a heterogeneous disease ranging from disease of inflammation at one end of the spectrum to aggressive malignancy at the other. Symptoms and endoscopic appearance are often quite similar, so information from imaging and histopathology are accessible to make real treatment decisions and make a final diagnosis. Contemporary consensus includes the fact that a multidisciplinary approach with the integration of clinical phenotype, CT/MRI-defined extent, and tissue diagnosis is important. Methods: We performed a retrospective observational study of 120 consecutive clinical cases of patients with clinically suspected sinonasal masses who attended a tertiary care center otorhinolaryngology unit (January 2023-December 2024). All patients received diagnostic examination with nasal endoscopy and with contrasting CT (and MRI - with the indication), followed by the biopsy or excision with histopathology confirmation. Radiological impressions were grouped into inflammatory/nectoplasm, benign neoplasm, and malignant neoplasms. Agreement between radiology and histopathology was determined by Cohen's kappa. Diagnostic performance metrics (sensitivity, specificity) were calculated with regard to malignancy prediction. Results: Nasal obstruction (90.0%) and rhinorrhea (52.5%) were the main symptoms. Histopathological diagnosis performed showed inflammatory polyps (37.5%), fungal rhinosinusitis (15.0%), inverted papilloma (11.7%), juvenile nasopharyngeal angiofibroma (6.7%), other benign lesions (5.8%) and malignancy (24.2%). Imaging features that were most commonly seen in malignancy included frank bony destruction, with/without orbital/intracranial extension, perineural spread, and necrotic enhancement. Radiology was 86.2% sensitive and 90.1% specific and had high agreement with histopathology (k=0.74). Inverted papilloma was most often misdiagnosed as a malignancy either when cerebriform architecture was absent or adjacent remodeling of the bone was misinterpreted as destructive change. Conclusion: Clinical evaluation alone, however, cannot suffice in the classification of causes of a sinonasal mass. A structured algorithm using endoscopy, CT to assess bone and surgical road mapping techniques, MRI for characterization of soft tissue, and histopathology results in a high diagnostic agreement and appropriately narrows a surgical approach and oncologic referral pathways.