CT osteitis severity flags the eosinophilic nasal-polyp endotype

Design

Prospective single-centre cohort with receiver-operating-characteristic analysis

Population

154 patients with chronic rhinosinusitis with nasal polyps

Primary outcome

Discrimination of eosinophilic endotype by CT osteitis score vs Lund-Mackay

Effect

Area under the curve 0.78 vs 0.66; threshold of one or more: sensitivity 70%, specificity 83%

Endotype matters in chronic rhinosinusitis with nasal polyps because the eosinophilic form behaves differently and responds differently to steroids, surgery and biologics. This prospective study of 154 patients asked whether CT-based osteitis severity, scored with the Kennedy Osteitis Score, could flag the eosinophilic endotype preoperatively.

Osteitis severity correlated with tissue eosinophil density (Spearman r 0.45) and discriminated the eosinophilic endotype with an area under the curve of 0.78, outperforming the conventional Lund-Mackay mucosal score at 0.66. A threshold of one or more gave 70% sensitivity and 83% specificity.

This offers a noninvasive, already-available imaging marker to help stratify endotype before histology is back, which could inform the extent of surgery and the case for biologic therapy. It is a single-centre study and an adjunct to, not a replacement for, histological confirmation.

• Prospective study of 154 patients with chronic rhinosinusitis with nasal polyps.
• CT osteitis severity correlated with tissue eosinophil density (r 0.45).
• It identified the eosinophilic endotype with area under the curve 0.78 vs 0.66 for Lund-Mackay.
• A threshold of one or more gave 70% sensitivity and 83% specificity.
• Use it to help stratify endotype preoperatively, not to replace histology.

Why it matters

It lets a scan already obtained hint at endotype before histology, informing how aggressively to treat and whether to consider a biologic.

Don't overread it

This was a single-centre study of discrimination, not outcomes; it does not show that acting on the CT score changes results.

The statistics, in plain English

An area under the curve of 0.78 is moderate-to-good discrimination, better than the 0.66 of the usual score; at the chosen threshold it misses about 30% of eosinophilic cases, so it supplements rather than replaces tissue diagnosis.

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