비용종을 동반한 만성 비부비동염의 내재형(endotype)에 따른 임상상과염색 방법에 따른 호중구성 비용종의 분류와 임상적 특징
Clinical Characteristics of Chronic Rhinosinusitis With Nasal Polyp According to Histopathological Endotypes and Staining Method for Neutrophilic Polyp Classification and Its Clinical Implication
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Background and Objectives There are various methods used to histologically assess thecell count of neutrophils in nasal polyps. With various classification of neutrophilic nasal pol-yps, determining the appropriate staining techniques and criteria is deemed important for thediagnosis of neutrophilic nasal polyps by assessing neutrophil cell counts. In this study, wetried to optimize different methods of neutrophil counting and staining by comparing clinicaloutcomes. Subjects and Method We studied 207 patients who underwent endoscopic sinus surgeryfor chronic rhinosinusitis with nasal polyp from August 2014 to September 2018. Patients’ na-sal polyp were taken to make following three slide sections: hematoxylin and eosin, humanneutrophil elastase (HNE), myeloperoxidase. After staining, microscope picture (×400) wastaken and neutrophils were counted. Neutrophil polyp (NP) was classified either by the tissueneutrophil count (20/HPF) or by the neutrophil percentage (1%/total cell) for clinical outcomecomparison. Results Two groups were made after HNE staining: the NP and the non-NP groups. TheL-K scores and delta showed significant differences between each group while neutrophil wasdefined based on 20 counts/HPF ( p<0.001). By Kaplan-Meier estimation, there was no statis-tical meaning between the two groups. But the NP group had a tendency to recur more thanthe non-NP group while 20 counts/HPF definition was used ( p>0.05). Conclusion HNE staining and 20 counts/HPF were the most specific for neutrophil count-ing. Analyzing the nasal polyp into two groups due to histologic types showed that the NPgroup had worse prognosis than the non-NP group. In conclusion, neutrophils in the nasal pol-yp might be considered seriously for clinical outcomes.
Abstract
Background and Objectives There are various methods used to histologically assess thecell count of neutrophils in nasal polyps. With various classification of neutrophilic nasal pol-yps, determining the appropriate staining techniques and criteria is deemed important for thediagnosis of neutrophilic nasal polyps by assessing neutrophil cell counts. In this study, wetried to optimize different methods of neutrophil counting and staining by comparing clinicaloutcomes. Subjects and Method We studied 207 patients who underwent endoscopic sinus surgeryfor chronic rhinosinusitis with nasal polyp from August 2014 to September 2018. Patients’ na-sal polyp were taken to make following three slide sections: hematoxylin and eosin, humanneutrophil elastase (HNE), myeloperoxidase. After staining, microscope picture (×400) wastaken and neutrophils were counted. Neutrophil polyp (NP) was classified either by the tissueneutrophil count (20/HPF) or by the neutrophil percentage (1%/total cell) for clinical outcomecomparison. Results Two groups were made after HNE staining: the NP and the non-NP groups. TheL-K scores and delta showed significant differences between each group while neutrophil wasdefined based on 20 counts/HPF ( p<0.001). By Kaplan-Meier estimation, there was no statis-tical meaning between the two groups. But the NP group had a tendency to recur more thanthe non-NP group while 20 counts/HPF definition was used ( p>0.05). Conclusion HNE staining and 20 counts/HPF were the most specific for neutrophil count-ing. Analyzing the nasal polyp into two groups due to histologic types showed that the NPgroup had worse prognosis than the non-NP group. In conclusion, neutrophils in the nasal pol-yp might be considered seriously for clinical outcomes.
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