Histopathology of routine nasal polypectomy specimens: a review of 2,147 cases

OBJECTIVES: There is controversy about whether all nasal polyps removed at operation should be sent for histopathologic examination. The primary aim of this study was to assess the incidence of unsuspected clinically relevant diagnoses in a large series of patients undergoing nasal polypectomy. A review of the literature on the frequency of this event was also performed. STUDY DESIGN: Retrospective study and review. METHODS: Data from patients undergoing nasal polypectomy over a 14 year period were reviewed. All adult patients undergoing first surgical removal of bilateral nasal polyps were included. Monolaterality and presence of suspicious looking lesions were exclusion criteria. RESULTS: A total of 2,147 patients were recruited. Eight cases of clinically relevant unexpected diagnoses were identified, corresponding to a frequency of 0.37% (95% confidence interval 0.16-0.73%). Inverted papilloma occurred in seven cases, neoplasia in one case. Affected patients tended to be older. Four previous smaller studies on this topic were identified. The reported incidence of unsuspected clinically relevant diagnoses varied between 0.00% and 0.92%. CONCLUSIONS: Although rare, unexpected clinically relevant findings may be identified during routine histologic examination of nasal polyps specimens. Future cost effectiveness analyses are required to clarify whether routine histology is a cost effective strategy.