Abstract
Objectives To compare the clinical utility of four juvenile nasal angiofibroma (JNA) staging
systems in a large cohort of patients.
Design Retrospective case series.
Setting Tertiary referral academic center.
Participants Pediatric patients undergoing surgical resection of JNAs between January 2008 and
June 2015.
Main Outcome Measures Intraoperative blood loss and transfusions, number of staged operations, postoperative
residual disease, and recurrent disease.
Results In total, 34 patients were identified; all underwent preoperative embolization followed
by surgery. Of the 34 patients, 33 (97%) underwent an exclusively endoscopic surgical
approach, with 6 (18%) requiring planned staged operations. Ten (29%) patients had
residual disease and three (9%) required further surgical resection. Using the area
under the curve (AUC) of receiver operating characteristic curves, the University
of Pittsburgh Medical Center (UPMC) staging system was most predictive of patients
who required staged procedures, received intraoperative transfusions, and had residual
postoperative disease (AUC: 0.89, 0.88, 0.86, respectively).
Conclusions The UPMC JNA staging system accounts for both route of skull base extension and tumor
vascularity, which are two important tumor attributes in the age of preoperative embolization
and endoscopic endonasal surgery. The UPMC staging system is a reliable modern staging
system that closely reflects prognostic information and aids in surgical planning.
Keywords
angiofibroma - endoscopy - surgery - standards - prognosis - retrospective study -
skull base pathologies
