Chapter 74 Differential diagnoses include fungal or bacterial infection, lymphocytic-plasmacytic rhinitis, bleeding disorders, and foreign bodies. Nasal radiographs may define changes in the nasal cavities and sinuses, but cross-sectional imaging (computed tomography [CT] or magnetic resonance imaging [MRI]) is preferred. Histologic confirmation is required for definitive diagnosis, although classic changes observed on CT or MRI scans combined with history and clinical signs are highly suggestive. The patient should be evaluated for potential coagulopathies before biopsy because postprocedure bleeding can be significant. The CT or MRI should be performed before biopsy to identify the optimal site from which to procure a specimen and to prevent postbiopsy bleeding from complicating the interpretation of the imaging study. A number of biopsy techniques have been described in the literature. Transnostril techniques are advantageous because they do not create a biopsy track that will have to be addressed if the patient is to be treated with surgery or radiation therapy. When this technique is used, one should make sure that the biopsy instrument is marked so that it penetrates no further than the medial canthus, which minimizes the risk to the cribriform plate and brain. Rhinoscopic techniques are minimally traumatic; however, even experienced operators can be frustrated by the inability to obtain a sample of sufficient quality and quantity for diagnosis. Nasal hydropulsion was reported recently as a minimally invasive technique that yielded samples from which a definitive diagnosis could be made in 90.2% of attempts (Ashbaugh et al, 2011). Although these tumors are unlikely to have metastatic spread, thoracic radiographs should be included in staging if radiation therapy is being considered as a treatment option.
Advances in Radiation Therapy for Nasal Tumors
Diagnostic Approach
Advances in Radiation Therapy for Nasal Tumors
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