Abstract
PURPOSE: Endoscopic sinus surgery (ESS) is a safe and effective intervention for medically refractory pediatric chronic rhinosinusitis (CRS), particularly in older children and those with nasal polyposis. However, the histopathological characteristics associated with poor surgical outcomes in pediatric chronic rhinosinusitis with nasal polyposis (CRSwNP) have not been fully clarified. This study aimed to to identify histopathological characteristics of CRSwNP prognostic for revision surgery. METHODS: We retrospectively reviewed the medical records of 161 pediatric patients with CRSwNP including 22 patients with recurrent nasal polyps requiring revision surgery. The histopathological characteristics were compared between patients with and without revision surgery. RESULTS: Histopathological analysis revealed that the degree of inflammation, interstitial-gland percentage, mucosal ulceration, and numbers of eosinophils and goblet cells were significantly higher in participants who underwent revision surgery than in those who did not (all P<0.05). The degree of inflammation (odds ratio [OR], 2.53; P=0.003), eosinophil count (OR, 1.03; P<0.001), goblet-cell count (OR, 1.19; P=0.002), interstitial-gland percentage (OR, 1.99; P=0.012), and mucosal ulceration (OR, 3.37; P=0.013) were significantly associated with revision surgery in the univariate regression analysis. Receiver operating characteristic curve analysis identified 2.5 goblet cells per high-power field as the optimal cutoff value for predicting revision surgery, with a sensitivity of 77.3% and a specificity of 67.6%. CONCLUSION: Histopathological features, including elevated eosinophil count, goblet-cell hyperplasia, marked mucosal inflammation, interstitial-gland hyperplasia, and mucosal ulceration, were associated with the need for revision in pediatric patients with CRSwNP. These findings could help clinicians stratify disease severity and tailor therapeutic approaches.