Published online: 2020-02-20

Original Article

Computed Tomography as a Predictor of

Sinonasal Inverted Papilloma Origin, Skull Base
Involvement, and Stage
Jake J. Lee1 Hilary L. P. Orlowski2 John S. Schneider1 Lauren T. Roland1,3,5 Rami Eldaya2
Pawina Jiramongkolchai1 Dorina Kallogjeri1 Rebecca D. Chernock4 Cristine N. Klatt-Cromwell1

1 Department of Otolaryngology-Head and Neck Surgery, Washington Address for correspondence Jake J. Lee, MD, Department of
University School of Medicine, St. Louis, Missouri, United States Otolaryngology-Head and Neck Surgery, Washington University
2 Department of Radiology, Washington University School of School of Medicine, 660 S Euclid Avenue, Campus Box 8115, St. Louis,
Medicine, St. Louis, Missouri, United States MO 63110, United States (e-mail: jakejlee@wustl.edu).
3 Department of Otolaryngology-Head and Neck Surgery, Emory
University School of Medicine, Atlanta, Georgia, United States
4 Department of Pathology, Washington University School of
Medicine, St. Louis, Missouri, United States
5 Department of Otolaryngology-Head and Neck Surgery, San
Francisco School of Medicine, University of California, San Francisco,
California, United States

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J Neurol Surg B

Abstract Objective To investigate the diagnostic performance of computed tomography (CT)

to determine the origin, skull base involvement, and stage of sinonasal inverted
papilloma (IP).
Design This is a retrospective cohort study.
Setting This is set at a tertiary care medical center.
Participants Patients with preoperative CT imaging who underwent extirpative surgery
for histologically confirmed sinonasal IP between January 2005 and October 2019.
Main Outcome Measures The likely sites of tumor origin, skull base involvement, and
radiographic tumor stage were determined by two board-certified neuroradiologists
after re-reviewing preoperative CT imaging. These radiologic findings were then
compared with intraoperative and pathologic findings.
Results Of 86 patients, 74% (64/86) had IP lesions with correctly classified sites of
origin on CT. CT was not sensitive for diagnosing ethmoid sinus origin (48%, 52%),
frontal sinus origin (80%, 40%), and skull base origin (17%, 17%). CT was not sensitive
(62%, 57%) but specific (86%, 98%) for identifying any skull base involvement. There was
substantial-to-near perfect agreement between radiographic and pathologic Cannady
Keywords stages (weighted κ ¼ 0.61 for rater 1; weighted κ ¼ 0.81 for rater 2). Interrater
► inverted papilloma agreement was substantial for identifying tumor origin (κ ¼ 0.75) and stage (weighted
► paranasal sinus κ ¼ 0.62) and moderate for identifying skull base involvement (κ ¼ 0.43).
► origin Conclusion Interrater agreement on CT findings was substantial except on skull base
► skull base involvement. CT correctly predicted site of tumor origin in up to 74% of subjects. CT
► stage was not sensitive for diagnosing skull base involvement but had substantial-to-near
► computed perfect agreement with pathologic tumor staging. CT is a useful but albeit limited
tomography adjunct for tumor localization and surgical planning for sinonasal IP.

received © Georg Thieme Verlag KG DOI https://doi.org/

May 10, 2019 Stuttgart · New York 10.1055/s-0040-1701677.
accepted after revision ISSN 2193-6331.
December 31, 2019
CT to Predict IP Origin and Skull Base Involvement Lee et al.
Introduction
Sinonasal inverted papillomas (IPs) are benign neoplasms of
the nasal cavity and/or paranasal sinuses that exhibit a
tendency for local soft tissue and osseous destruction, recur-
rence, and malignant transformation.1–4 They comprise 4%
of all primary nasal neoplasms and have an overall malig-
nancy rate of 7 to 11%.3,5–7 Both benign and malignant
sinonasal IPs are locally aggressive, often resulting in osseous
erosion with extension beyond the paranasal sinuses into the
intracranial compartment, orbit, pterygopalatine fossa, and
infratemporal fossa.8–10 In addition, there are high rates of
local recurrence ranging between 14 and 33%, most of which
occur at the original resection site.5,6,11,12 As a result, the
standard of care for treatment of sinonasal IP is complete
surgical resection, which can be achieved via endoscopic
endonasal, open, and combined approaches.13–15
To better delineate tumor origin and extension for surgical
planning and intraoperative navigation, preoperative assess-
ment with computed tomography (CT) is often performed.
CT features such as opacification and surrounding osteitic
changes including focal hyperostosis, bony struts, osseous
thinning, dehiscence, and intratumoral calcification are pre-
dictors of tumor origin and attachment to underlying sino-
nasal and anterior skull base structures.16–21 Multiple prior
studies have reported the positive predictive value of CT for
determining sinonasal IP origin is up to 89 to 100%.16,18,20,21
However, these studies were limited by small sample sizes
ranging from 24 to 55 total lesions. A recent study utilizing a
larger sample size of 143 patients determined CT’s prediction
rate of tumor origin to be much lower at 50% compared with
prior studies; however, more than 50% of that sample com-
prised patients with recurrent IP as opposed to primary IP.17
In addition to determining tumor origin, CT also has the
ability to predict tumor extension and thus stage. Compared
with the gold standard of intraoperative and pathologic
assessment for tumor staging using the Krouse classification
system, CT was able to correctly stage 80% of IP lesions while
overstaging 13% and understaging 7% in one study.20
Krouse’s study, however, was limited by its sample size of
26 subjects, and no prior study has specifically examined CT’s
ability to determine involvement of the skull base. Due to
inconsistencies and use of limited sample sizes in the exist-
ing literature as well as gaps in knowledge regarding tumor
extension, the aim of this study was to comprehensively
investigate the diagnostic performance of CT in determining
tumor origin, involvement of the skull base, and stage.
Materials and Methods
We conducted a single-center retrospective cohort study of
consecutive patients with histologically confirmed primary
sinonasal IP. Institutional Review Board approval was obtained
prior to initiation of chart review and data collection. Inclusion
criteria included: (1) patients with evidence of sinonasal IP on
histopathology, (2) patients who had preoperative CT scans in
1  1 mm slices, and (3) patients who underwent sinonasal
surgical resection between January 2005 and October 2019. All
Journal of Neurological Surgery—Part B
patients with sinonasal IP were identified using an electronic
clinical database maintained by the Department of Pathology.
Exclusion criteria included: (1) patients with inaccessible or
poor quality CT imaging as determined by a collaborating
board-certified neuroradiologist, (2) patients who underwent
sinonasal surgery, excluding biopsies, less than 3 months
before their index CT scans, and (3) those presenting to our
institution with recurrent IP.
Two board-certified neuroradiologists, who were blinded to
operative and pathologic findings and to each other’s grading,
re-reviewed all CT scans to assess for likely tumor origin, skull
base involvement, and radiographic Krouse and Cannady
stages.8,10 Operative notes and pathology reports were
reviewed to determine actual tumor attachment site, tumor
extension, skull base involvement, and pathologic tumor stage.
On CT in order of importance, the likely site of tumor origin was
designated by (1) focal hyperostosis, defined as localized
eccentric bony thickening of a portion of a nasal cavity struc-
ture or paranasal sinus (►Fig. 1A), (2) focal osseous erosion
(►Fig. 1B), or (3) adjacency of an osseous structure to the bulk
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of sinonasal opacity in the absence of the first two osseous
changes. Soft tissue windows were utilized for additional
guidance when needed. Intraoperatively, tumor origin was
defined as the primary attachment site where the sinonasal
IP lesion was pedicled to the underlying mucosa and bone.
Skull base involvement was defined as IP of any origin that
extended toward the skull base and was adherent to mucosa
and/or bone. By definition, any IP originating from the skull
base, by definition, had skull base involvement but not vice
versa. On CT bone windows, tumor was deemed to involve the
skull base when (1) focal hyperostosis, (2) osteolytic changes,
or (3) osseous thinning of the skull base was present (►Fig. 2).
Radiographic skull base involvement was considered negative
in the absence of osseous changes, even in cases of mucosal
thickening. Intraoperatively, IP was deemed to involve the
skull base if oncologic resection required mucosal and/or bony
debridement and drilling at the level of the skull base.
All paranasal sinus CTscans at our institution were acquired
using 0.6 mm slices. The standard protocol, which extends
from above the frontal sinus to below the maxillary sinus, then
sends 1  1 mm slices (slice thickness [mm]  recon increment
[mm]) using an H60f bone kernel in the axial plane. These
images are then reconstructed in axial 2  2 mm slices in H20f
soft tissue kernel and in coronal H60f bone kernel. The Stealth
landmark protocol, which extends from the skull vertex to the
hard palate, sends axial bone and soft tissue images and
coronal images using the above-listed kernels in 1  1 mm
slices. All CT scanners were designed by Siemens (Malvern,
Pennsylvania, United States).
Descriptive statistics were used to explore the distribution
of demographic and clinical characteristics of the study popu-
lation. CT’s rate of correctly classifying the site of origin and
tumor stage was calculated. Cohen’s kappa (κ) was used to
assess agreement of radiographic tumor origin and skull base
involvement between the two neuroradiologists. Linearly
weighted kappa was calculated to assess the degree and
closeness of agreement in radiographic tumor stage between
the two neuroradiologists as well as between radiographic and
 CT to Predict IP Origin and Skull Base Involvement Lee et al.

Fig. 1 (A) Coronal computed tomographic (CT) image through the sinuses in bone windows demonstrates focal hyperostosis of the left lateral

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lamella and fovea ethmoidalis adjacent to opacification, suggesting skull base involvement and tumor attachment. (B) Coronal CT image
demonstrates bony erosion and dehiscence of the right fovea ethmoidalis and lateral lamella. While not pictured, there were no other sites with
osteitic changes so both radiologists designated these inverted papilloma lesions to be of skull base origin.

Fig. 2 (A) Coronal computed tomographic (CT) bone window of a patient with focal hyperostosis of the right fovea ethmoidalis and osteitic changes of the
anterior ethmoid partitions. (B) Sagittal CT bone window of the same patient demonstrating focus of hyperostosis at the anterior ethmoid partitions, which
extends to the skull base. Since the focus was in the anterior ethmoid but also extended to the skull base, this patient was deemed to have sinonasal IP of
ethmoid origin with skull base involvement. (C) Sagittal CT bone window of a different patient with hyperostosis of the inferior sphenoid sinus bone and
thinning of the clivus adjacent to the bulk of opacification. Dehiscence of the planum sphenoidale adjacent to opacification is also seen. This patient was
deemed to have inverted papilloma of sphenoid origin with skull base involvement.

pathologic tumor stages. Weighted kappa was utilized instead Results

of unweighted kappa to compare across staging systems
because three-stage discrepancies (e.g. T1 vs. T4) should be
weighted more than two-stage discrepancies (e.g. T1 vs. T3),
which should be weighted more than one-stage discrepancies
(e.g. T2 vs. T3). The κ-value was interpreted according to Landis
and Koch’s classification system.22 Sensitivity, specificity, and
accuracy of CT versus the gold standard of surgical exploration
to correctly identify tumor origin and skull base involvement
were also calculated. Precision of estimates was calculated
using 95% confidence intervals (CIs) around point estimates.
Statistical calculations were performed with SPSS 25 (IBM
Corp., Armonk, New York, United States) and STATA 15 (College
Station, Texas, United States).
A total of 86 eligible patients with pathologically confirmed
sinonasal IP who underwent surgical resection were investi-
gated (►Table 1). CT imaging was performed at a median of
26 days before surgery (interquartile range: 14–46 days) with
87% (75/86) of subjects undergoing CT imaging within
2 months before surgery. CT correctly identified the site of
origin in 72% (62/86) and 74% (64/86) of patients for neurora-
diologist raters 1 and 2, respectively (►Table 2). There was
substantial agreement on radiographic tumor origin between
the two neuroradiologists (κ ¼ 0.75, 95% CI: 0.63–0.86). When
assessed by individual sinonasal site, CT was most sensitive for
identifying nasal cavity origin (100% for rater 1 and 93% for

Journal of Neurological Surgery—Part B

CT to Predict IP Origin and Skull Base Involvement Lee et al.

Table 1 Distribution of demographic and clinical characteristics all sites of origin except for nasal cavity (75% for rater 1 and
of the study population 80% for rater 2).
Within the total cohort, 24% (21/86) had tumor involving
Characteristic Total sample the skull base, of which 62% (13/21) and 57% (12/21) were
(n ¼ 86) correctly identified by raters 1 and 2, respectively (►Table 4).
Age at diagnosis, median (min–max) 61 (12–87) y The strength of agreement was only moderate between the
Sex two neuroradiologists (κ ¼ 0.43, 95% CI: 0.20–0.65). For rater
1, CT had 62% sensitivity (95% CI: 39–81%), 86% specificity
Male 54 (63%)
(95% CI: 75–93%), and 80% accuracy for diagnosing skull base
Female 32 (37%)
involvement. For rater 2, CT had 57% sensitivity (95% CI:
Race 34–77%), 98% specificity (95% CI: 91–100%), and 88% accura-
White 55 (64%) cy for detecting skull base involvement.
Black 24 (28%) Next, using the Krouse classification system for tumor
staging, radiographic staging was found to be concordant
Other 7 (8%)
with pathologic staging in 70% (60/86) and 84% (72/86) of
Associated carcinoma 6 (7%) patients for raters 1 and 2, respectively (►Table 5). Interrater
Surgical approach agreement was substantial (weighted κ ¼ 0.62, 95% CI:
Endoscopic endonasal only 76 (88%) 0.49–0.76), and there was moderate-to-substantial agree-
ment between radiographic and pathologic Krouse stages
Open 2 (3%)
(weighted κ ¼ 0.57, 95% CI: 0.43–0.70 for rater 1; weighted

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Combined 8 (9%)
rater 2) and least sensitive for identifying ethmoid and (48% for
rater 1 and 52% for rater 2) skull base origin (17% for both
raters) (►Table 3). More specifically, the six IP lesions that
were classified as originating from the skull base were pedicled
to the lateral lamella (n ¼ 2), fovea ethmoidalis (n ¼ 2), planum
sphenoidale (n ¼ 1), and temporal fossa (n ¼ 1) adjacent to the
lateral sphenoid recess. CT had specificity >90% for identifying
κ ¼ 0.79, 95% CI: 0.68–0.89 for rater 2). Similarly, when
utilizing the Cannady staging system, radiographic staging
was concordant with pathologic staging in 77% (66/86) and
87% (75/86) of patients for raters 1 and 2, respectively, and
interrater agreement was once again substantial (weighted
κ ¼ 0.62, 95% CI: 0.47–0.77) (►Table 6). There was substan-
tial-to-almost perfect agreement between radiographic and
pathologic Cannady stages (weighted κ ¼ 0.61, 95% CI:
0.45–0.76 for rater 1; weighted κ ¼ 0.81, 95% CI: 0.71–0.92
for rater 2).

Table 2 Identification of site of tumor origin by CT interpretation and intraoperative assessment

Nasal Maxillary Ethmoid Frontal Sphenoid Skull Total

cavity sinus sinus sinus sinus base
intraop intraop intraop intraop intraop intraop
Rater 1
Nasal cavity on CT 15 3 10 1 1 3 33
Maxillary sinus on CT 0 26 2 0 0 0 28
Ethmoid sinus on CT 0 0 11 0 0 1 12
Frontal sinus on CT 0 0 0 4 0 0 4
Sphenoid sinus on CT 0 0 0 0 7 1 8
Skull base on CT 0 0 0 0 0 1 1
Total 15 29 23 5 8 6 86
Rater 2
Nasal cavity on CT 14 2 8 0 1 3 28
Maxillary sinus on CT 0 26 2 0 0 0 28
Ethmoid sinus on CT 0 1 12 3 0 1 17
Frontal sinus on CT 0 0 1 2 0 0 3
Sphenoid sinus on CT 1 0 0 0 7 1 9
Skull base on CT 0 0 0 0 0 1 1
Total 15 29 23 5 8 6 86

Abbreviations: CT, computed tomography; intraop, intraoperative.

Journal of Neurological Surgery—Part B

 CT to Predict IP Origin and Skull Base Involvement Lee et al.

Table 3 Diagnostic test characteristics of computed tomography Table 5 Distribution of radiographic and pathologic Krouse
versus the gold standard of surgical exploration stage for each sinonasal inverted papilloma

Sensitivity Specificity Accuracy pT1 pT2 pT3 pT4 Total

(95% CI) (95% CI)
Rater 1
Nasal cavity origin
rT1 2 6 1 0 9
Rater 1 100% (75–100%) 75% (63–84%) 79%
rT2 0 9 1 1 11
Rater 2 93% (66–100%) 80% (69–88%) 83%
rT3 1 5 40 5 51
Maxillary sinus origin
rT4 0 1 5 9 15
Rater 1 90% (72–97%) 96% (87–99%) 94%
Total 3 21 47 15 86
Rater 2 90% (72–97%) 96% (87–99%) 94%
Rater 2
Ethmoid sinus origin
rT1 2 2 0 0 4
Rater 1 48% (27–69%) 98% (90–100%) 85%
rT2 1 17 3 0 21
Rater 2 52% (31–73%) 92% (82–97%) 81%
Frontal sinus origin
rT3 0 2 42 4 48

Rater 1 80% (30–99%) 100% (94–100%) 99% rT4 0 0 2 11 13

Rater 2 40% (7–83%) 99% (92–100%) 95% Total 3 21 47 15 86

Sphenoid sinus origin Abbreviations: pTx, pathologic T stage; rTx, radiographic T stage.

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Rater 1 88% (47–99%) 99% (92–100%) 98%
Rater 2 88% (47–99%) 97% (90–100%) 97% Table 6 Distribution of radiographic and pathologic Cannady
Skull base origin stage for each sinonasal inverted papilloma
Rater 1 17% (1–64%) 100% (94–100%) 94%
pT1 pT2 pT3 Total
Rater 2 17% (1–64%) 100% (94–100%) 94%
Rater 1
Abbreviation: CI, confidence interval.
rT1 17 2 1 20
rT2 5 40 5 50
Table 4 Identification of skull base involvement by CT
interpretation and intraoperative assessment rT3 2 5 9 16
Total 24 47 15 86
Skull base Skull base Total
Rater 2
involved uninvolved
intraop intraop rT1 22 3 0 25
Rater 1 rT2 2 42 4 48
Skull base 13 9 22 rT3 0 2 11 13
involved on CT
Total 24 47 15 86
Skull base 8 56 64
uninvolved on CT Abbreviations: pTx, pathologic T stage; rTx, radiographic T stage.

Total 21 65 86 and there was only moderate agreement in identifying skull

Rater 2 base involvement between the two raters. For both the Krouse
Skull base 12 1 13 and Cannady tumor staging systems, interrater agreement was
involved on CT substantial. For the Krouse system, there was moderate-to-
Skull base 9 64 73 substantial agreement between radiographic and pathologic
uninvolved on CT tumor stages, and for the Cannady system, the agreement was
Total 21 65 86 stronger, demonstrating substantial-to-almost perfect agree-
ment between radiographic and pathologic tumor stages.
Abbreviations: CT, computed tomography; intraop, intraoperative. CT was least sensitive for diagnosing ethmoid and skull base
origin. This decreased sensitivity in determining ethmoid
Discussion origin may be a result of the proximity of ethmoid air cells to
the frontal sinus outflow tract, frontal sinus, ostiomeatal
In this study of 86 patients, CT correctly predicted the site of complex, maxillary antrum, sphenoid sinus ostia, and skull
sinonasal IP origin in up to 74% of subjects, and agreement base and ability of tumor to extend to those areas. Alternatively,
between two separate neuroradiologists was substantial. CT it may also be due to the heterogeneous and thin distribution of
also demonstrated substantial agreement with intraoperative bone around the ethmoid air cells, which may hinder identifi-
assessment for both raters. While very specific, CT was not cation of osteitic changes on imaging. The decreased accuracy
sensitive for determining skull base involvement by tumor, in predicting skull base origin may be due to concurrent

Journal of Neurological Surgery—Part B

CT to Predict IP Origin and Skull Base Involvement Lee et al.
opacification and osteitic changes of adjacent sinuses such as
the ethmoid sinuses for the four lesions attached to the lateral
lamella and fovea ethmoidalis and the sphenoid sinus for the
lesions originating at the planum sphenoidale and temporal
fossa superior to the lateral sphenoid recess.
Our study is the largest to assess the diagnostic ability of
CT for primary sinonasal IP to date. Prior studies have demon-
strated superior prediction rates of sinonasal IP origin for CT
ranging between 89 and 100%.16,18,20,21 However, these studies
were limited by their small sample sizes and may have been
prone to selection bias by only examining CT images of IP
lesions that demonstrated osteitis. The most recent study of
143 patients assessed CT scans of IP lesions including those that
did not clearly demonstrate osteitic changes on imaging, which
revealed that CT accurately determined tumor attachment site
in only 50% of patients; however, more than half the cohort
comprised patients with recurrent IP lesions, which may
represent a dissimilar population compared with patients
with primary IP.17 Our analysis attempted to similarly avoid
selection bias and enhance generalizability by including all CT
images rather than just those with osteitic signs and having two
blinded independent neuroradiologists rate every CT scan. This
study’s prediction rate of 72 or 74%, depending on the neuro-
radiologist, is firmly between the literature’s divergent results.
In addition, the concordance rate between radiographic and
pathologic tumor staging in our study was 70 or 84% and 77 or
87% using the Krouse and Cannady classification systems,
respectively, which was similar to the previous study of 26
patients who reported a concordance rate of 80% using the
Krouse system.20
Unique to this study, we also assessed skull base involve-
ment as a separate outcome variable. Skull base involvement is
clinically relevant for preoperative planning when considering
equipment needs, whether or not to involve a neurosurgical
team for a multidisciplinary approach, and preparation for
potential complications such as cerebrospinal fluid leak and
their concomitant solutions. This study found that CT was very
specific but not sensitive for diagnosing skull base involve-
ment. The clinician should therefore consider the substantial
false-negative rate when assessing skull base-related CT
results. Another drawback of CT is that interrater agreement
of skull base involvement was only moderate between the two
neuroradiologists. Given CT’s high specificity, if focal hyperos-
tosis or osteolytic changes of the skull base are present per the
criteria used in this study, the skull base will most likely
be involved intraoperatively, and preoperative plans should
be made accordingly. If further characterization is desired, the
clinician should consider magnetic resonance imaging (MRI)
as part of his/her presurgical work-up, which will better
delineate intracranial extension and dural involvement based
on IP’s distinctive convoluted cerebriform pattern.23 In theory,
advanced knowledge of sinonasal IP origin, skull base involve-
ment, and extension through imaging would better enable
clinicians to plan the surgical approach, extent of surgical
resection, and reconstructive technique, but based on this
study’s findings, these decisions should not be made with CT
alone, especially when IP is localized to the ethmoid air cells
and skull base.
Journal of Neurological Surgery—Part B
This study does have several limitations. Due to the study’s
retrospective nature, the research team had to rely on in-office
clinician notes, operative summaries, and pathology reports
when determining tumor origin, skull base involvement, and
stage. While the sample size of 86 is one of the largest for a
radiographic study on sinonasal IP, it still resulted in an
imprecision of estimates for our outcomes as demonstrated
by the wide 95% CI. Another limitation is that 72% (62/86) of the
study population had complex stages 3 and 4 tumors, likely
related to referral bias within our tertiary care institution.
Furthermore, some patients underwent CT imaging after biop-
sy or partial debulking of the IP lesion before the pathology was
known, which may affect radiographic interpretation. Finally,
while previous studies have listed various radiographic signs as
markers for site of sinonasal IP origin, they have not been
validated and standardized into established criteria.16–18,20,21
In sum, this study is unique when compared with existing
studies in the literature by comprehensively assessing the
interrater reliability and diagnostic performance of CT for
detecting multiple sinonasal IP features, including origin, skull
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base involvement, and stage in the largest cohort of patients
with primary sinonasal IP to our knowledge. Future directions
include a large multicenter retrospective or prospective cohort
study utilizing multiple board-certified neuroradiologists
and/or otolaryngologists who are blinded to operative out-
comes with an assessment of interrater agreement on CT and
MRI findings and a comparison of diagnostic accuracy between
the two imaging modalities.
Conclusion
Based on preoperative CT, there was substantial interrater
agreement for determining site of sinonasal IP origin and
tumor stage. Interrater agreement was only moderate for
identifying skull base involvement. CT correctly predicted
site of tumor origin in up to 74% of subjects. While specific,
CT was not sensitive for diagnosing skull base involvement. CT
demonstrated substantial-to-near perfect agreement with
intraoperative assessment for determining tumor stage. CT
appears to be a useful but limited adjunct for tumor localiza-
tion and surgical planning for sinonasal IP.
Note
Poster presented at the North American Skull Base Society
2019 Annual Meeting, Orlando, Florida, United States,
February 16, 2019.
Conflict of Interest
None.
Funding
Research reported in this publication was supported by
the National Institutes of Health (NIH) under Award
Number 5T32DC000022-30 and by the National Center
for Advancing Translational Sciences of the NIH under
award number UL1TR002345. The content is solely the
responsibility of the authors and does not necessarily
represent the official views of the NIH.
 CT to Predict IP Origin and Skull Base Involvement
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