A prospective analysis evaluating tissue biopsy location and its clinical relevance in chronic rhinosinusitis with nasal polyps

Abstract

Background Chronic rhinosinusitis with nasal polyps (CRSwNP) has a high propensity for recurrence. Studies suggest that eosinophilia influences disease severity and surgical outcomes, but the selection of sinonasal site for measuring eosinophilia has not been examined. The aim of this study was to investigate how region-specific tissue eosinophilia affects radiographic severity, comorbidity prevalence, and polyp recurrence risk following sinus surgery. Methods Eosinophil cationic protein (ECP) levels in uncinate tissue (UT) and nasal polyp (NP) homogenates from 116 CRSwNP patients were measured using enzyme-linked immunosorbent assay (ELISA). Clinical history, radiographic severity, and time to polyp recurrence were obtained from electronic health records. The correlations between baseline Lund-Mackay scores and comorbidities were compared between UT and NP ECP levels. Cox regression and Kaplan-Meier analysis were then performed to assess whether UT or NP ECP better predicted recurrence. Censoring occurred at 4 years or at last follow-up if there was no endoscopic diagnosis of recurrent polyps. Results Lund-Mackay scores were significantly correlated with UT and NP ECP (r = 0.46 and 0.26 respectively, p < 0.05). UT but not NP ECP was significantly higher in patients with asthma (p < 0.01) and aspirin-exacerbated respiratory disease (AERD) (p < 0.05). Polyp recurrence risk was only significantly higher for patients with eosinophilic UT tissue (hazard ratio [HR] = 2.84, p = 0.025). When measured in NP, eosinophilia did not predict recurrence. Conclusion Although ECP in NP was higher than in UT tissue, eosinophilia in UT tissue was a more clinically coherent biomarker of baseline radiographic severity, comorbid asthma and AERD, and prospective polyp recurrence risk than NP eosinophilia.

Mucus T helper 2 biomarkers predict chronic rhinosinusitis disease severity and prior surgical intervention

“…However, this approach is inherently invasive and is limited by differences in localized marker expression throughout the nasal and sinus cavity 23 . The ideal CRS biomarker should be easily assayed, allow for accurate identification of disease subtypes with clinical relevance, and identify patients who may benefit from individualized therapies.…”

“…Improved understanding of CRS pathophysiology and early attempts to identify CRS endotypes and phenotypes have largely depended on analysis of sinonasal tissue, typically in the form of surgically excised biopsy specimens. However, this approach is inherently invasive and is limited by differences in localized marker expression throughout the nasal and sinus cavity 23 . The ideal CRS biomarker should be easily assayed, allow for accurate identification of disease subtypes with clinical relevance, and identify patients who may benefit from individualized therapies.…”

Longitudinal stability of chronic rhinosinusitis endotypes

“…Mucus biomarkers have several advantages over surgically obtained tissue in its minimally invasive, yet comprehensive sampling of inflammatory mediators without being limited by potential variability in site-specific protein expression. 6 Repeat mucus collection was performed no sooner than 6 months after initial sampling (median = 15.5 months; range 10-41 months), the point following which few changes in postoperative disease-specific QoL are thought to occur and a suggested primary end-point of CRS clinical studies. 7 As previously described, inflammatory burden in individual samples was measured using a multiplex assay that reflects various TH1/TH2/TH17-associated cytokines 5 (Table 1).…”

Microbiome profiling reveals distinct microbial compositions of nasal polyps in chronic rhinosinusitis

“…The immunological pro le of UT has been demonstrated to differ according to disease status. For instance, the eosinophil cationic protein (ECP) level in UT is strongly correlated with overall disease severity, comorbid asthma, and the risk of polyp recurrence (25,26). Furthermore, speci c immunological characteristics of UT in different disease subtypes (6,27) seem to be associated with the distinguishing microbiome pro le.…”