Clinical-cytological-grading and phenotyping in patients with chronic rhinosinusitis with nasal polyps: the relevance in clinical practice

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M. Gelardi, G. Porro, V. Quaranta, N. Quaranta, M. Cassano, G. Ciprandi, Alonzi Luigi, Arnone Caruso Arturo, Barbara Francesco, Barbara Michele, Castelnuovo Paolo, Ciancio Giovanna, Ciofalo Andrea, Curatolo Michele, De Candia Nicola, De Luca Carlo, De Robertis Valentina, Di Benedetto Valentina, Fiore Valeria, Iannuzzi Lucia, Imperatore Clara, Lingua Cristiano, Lombardo Giuseppe, Macchi Alberto, Mancini Michela, Maselli del Giudice Alessandro, Mola Patrizia, Notargiacomo Mario, Palma Antonio, Pecoraro Piero, Pellitteri Giuseppe, Piccininni Krizia, Rinaldi Massimo, Rossi. Study Group On CRSwNP I. Valentina
ISSN: 1122-0643

Chronic rhinosinusitis (CRS) includes two main phenotypes: without nasal polyps (CRSsNP) and with nasal polyps (CRSwNP). CRSwNP may be associated with comorbidity, mainly concerning asthma, aspirin intolerance, and allergy. CRSwNP patients may also be evaluated by clinical-cytological grading (CCG). The current study investigated the prevalence and characteristics of the different CCG and phenotypes in CRSwNP outpatients examined in clinical practice. This retrospective cross-sectional study enrolled 791 consecutive CRSwNP outpatients (424 males, mean age 48.8 years). In the total population, asthma was a common comorbidity (30.8%) as well as aspirin intolerance (24.8%), and allergy (50.8%). As concerns CCG-grading, 210 (26.5%) outpatients had low-grade, 366 (46.3%) medium, and 215 (27.2%) high. As regards cytological phenotypes, 87 (11%) had neutrophilic type, 371 (46.3%) eosinophilic, 112 (14.2%) mast cell, and 221 (27.9%) mixed. High-grade CCG was significantly associated with more frequent asthma, aspirin intolerance, allergy, recurrent surgery, and mixed cytological phenotype. Low-grade CCG was characterized by fewer comorbidities and operations, and neutrophilic phenotype. Therefore, the present study confirmed that CCG is a useful tool in the management of outpatients with CRSwNP. CRSwNP is frequently associated with asthma, aspirin intolerance, and allergy comorbidity. High-grade CCG is frequently characterized by a mixed cytological phenotype, thus, by more severe progress. These real-world outcomes underline that CRSwNP deserves adequate attention for careful management and optimal identification of the best-tailored therapy; CCG and cytological phenotyping could be fruitful tools in clinical practice. Asthma and aspirin intolerance should be adequately investigated in all CRS patients.

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