HPV‐Positive Status Is an Independent Factor Associated With Sinonasal Inverted Papilloma Recurrence

Abstract

Objectives: The present study aimed to evaluate human papillomavirus (HPV) occurrence in sinonasal inverted papilloma (SNIP), and to assess factors associated with HPV positivity and SNIP recurrence.Study Design: Prospective study. Methods: We prospectively collected clinical data and fresh tissue specimens from 90 consecutive patients treated for SNIP at Helsinki University Hospital, between 2015 and 2019. Fourteen patients with recurrent SNIP underwent repeated tumor sampling. All tissue specimens were analyzed for the presence of HPV. Factors associated with SNIP recurrence and HPV positivity were assessed.Results: Among 107 SNIP specimens, 14 (13.1%) were positive for low-risk HPV and 6 (5.6%) were positive for high-risk HPV. HPV positivity was associated with an increased risk of recurrence (P = .004). Smoking was significantly associated with HPV positivity in SNIP (P = .01), but a history of HPV-related diseases or patient sexual habits did not correlate with HPV positivity. The recurrence rate was lower among patients with SNIP that underwent an attachment-oriented resection, compared to patients treated without attachment-oriented resections (78.6% vs 25.8%, P < .001).Conclusions: The risk of SNIP recurrence was highly associated with 1) HPV positivity and 2) surgery without an attachment-oriented resection. Oncogenic HPV was rare in SNIP.

The choice of endoscopic surgical approach and four steps of operation of inverted papilloma of the maxillary sinus

“…Identification of the IP attachment site is vital for preventing the recurrence. Most of scholars reported that the attachment site may be accurately identified [ 11 , 22 ]. In this study, although 28.9% had the history of previous surgery, MMA alone or Caldwell-Luc approach alone was performed in initial surgery, the attachment site hadn’t been eradicated, thus, the IP attachment sites were identified in all the patients.…”

“…The preferred treatment for IP is minimally invasive, attachment-oriented endoscopic surgery. This surgery includes the identification of the tumor attachment site, a subperiosteal dissection, and a resection or drilling of the underlying bone [ 1 , 10 , 11 ]. Despite the theoretical advantage of subperiosteal dissection and bone drill, these techniques have still shown high tumor recurrence rates.…”

“…The correlation of the recurrence of IP and human papillomavirus (HPV) has been widely studied in recent but remained conflicting results [ 11 , 24 – 27 ]. Some scholars believed that HPV infection is significantly associated with the recurrence of IP, especially for high-risk genotypes 16 and 18 [ 11 , 24 , 26 , 27 ], while other found no correlation between risk of recurrence and HPV positivity [ 25 ]. Unfortunately, HPV testing was not performed in this study.…”

“…In recent years, endoscopic medial maxillectomy or inferior meatal antrostomy (IMA) combined with MMA was performed to to adequately access all the wall of MS using straight instrument, thereby attempt to completely remove the tumor [ 1 , 2 , 8 , 9 ]. In addition, endoscopic attachment-oriented surgery has became gold standard approach for the treatment of IP of MS in recent years, the approach includes the identification of the tumor attachment site, a subperiosteal dissection, and a resection or drilling of the underlying bone [ 1 , 10 , 11 ].…”

Sinonasal inverted papilloma – malignant transformation and non‐sinonasal malignancies

“…However, the difference between stages T1 and T2, and also between T3 and T4, is insignificant 2 . A higher prevalence of HPV infection, and also increased risk for SNIP recurrence have been observed in smokers 3,4 . The risk for SNIP recurrence may also depend on surgical technique.…”