Preoperative washing cytology in the diagnosis of maxillary sinus lesions.

Objective: To assess the preoperative value of washing cytology in maxillary sinus lesions with suspected malignancy.

Study Design: Over a 4-year period, 96 p tients with clinical or radiologic suspicion of a malignant maxillary sinus tumor either confined to the maxillary complex or extending to the nasal cavity underwent preoperative cytologic evaluation by sinus puncture and local washing or nasal washing. Subsequently all patients underwent endoscopic sinus surgery (ESS) and partial or total maxillectomy. For controls, 10 patients with rhinosinusitis, who according to standard symptoms and radiologic scores, were candidates for ESS, washing cytology and subsequent random mucosal biopsy were used.

Results: There were 47 malignant, 42 benign and 7 borderline cases. Benign lesions included inflammatory conditions (17), squamous proliferations (6), soft tissue lesions (9) and odontogenic lesions (10). Borderline lesions included hemangiopericytoma (4) and ameloblastoma (3). Malignant lesions included squamous cell carcinoma (8), sinonasal adenocarcinoma (2), salivary gland tumors (4), soft tissue tumors (18), malignant melanoma (8) and hematolymphoid neoplasms (7). The overall sensitivity, specificity, positive predictive value and negative predictive value of preoperative washing cytology were 88.6%, 88.2%, 86.6%, 90%, respectively. Diagnostic agreement between cytology and follow-up biopsy was seen mostly in benign inflammatory and odontogenic lesions and in squamous cell carcinoma and salivary gland malignancies.

Conclusion: Preoperative sinus washing cytology is a noninvasive and rapid method of diagnosis, with a definite impact on patient surgical planning. Clusters of sloughed epithelial cells, so called Creola bodies, may be a diagnostic pitfall in benign lesions.