- Design
- Prospective cohort study
- Population
- 154 patients with chronic rhinosinusitis with nasal polyps, Vietnam
- Primary outcome
- Discrimination of eosinophilic endotype by CT scores
- Effect
- Kennedy Osteitis Score AUC 0.777 vs Lund-Mackay 0.661; threshold 1 or more: sensitivity 69.6%, specificity 83.3%
Knowing whether nasal polyps are eosinophilic before surgery helps predict recurrence and guides the case for steroids or biologics. This prospective study of 154 patients at a tertiary centre in Vietnam compared the CT Kennedy Osteitis Score with tissue eosinophil counts (eosinophilic defined as 10 or more per high-power field).
Osteitis severity correlated with tissue eosinophils (rs 0.45) and remained independently associated after adjustment. It discriminated eosinophilic disease better than the Lund-Mackay mucosal score (AUC 0.777 vs 0.661). An osteitis score of 1 or more gave sensitivity 69.6% and specificity 83.3%.
Osteitis can be read from the CT already done for surgical planning, so the marker costs nothing. It is not accurate enough to replace histology, but it can prompt earlier discussion of recurrence risk and medical therapy.
- Look for bony thickening of sinus walls on every preoperative CT for nasal polyps
- Record the osteitis score alongside Lund-Mackay
- Treat any osteitis as a flag for likely eosinophilic, recurrence-prone disease
- Confirm the endotype with tissue eosinophil counts at surgery
- Discuss long-term steroid rinses early in patients with osteitis
Why it matters
It gives a free, preoperative signal of the endotype that drives recurrence.
Don't overread it
A single-centre study; sensitivity of 70% means osteitis-free scans do not exclude eosinophilic disease.
The statistics, in plain English
An AUC of 0.78 is fair to good discrimination; 0.66 is weak. Specificity of 83% means about one in six non-eosinophilic patients would still be flagged.
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