(1220) Do Radiological and Histological parameters predict clinical behavior of mid-facial sinonasal fibro-osseous lesions?

Introduction:

Objective: To evaluate whether histological and radiological parameters influence the clinical course of fibrous dysplasia (FD) and ossifying fibroma (OF) given their considerable overlap.

Methods: Study

Design: Ambispective observational study.
Setting: Otolaryngology facility of University Hospital of North India.

Methods: Review of clinical records and reevaluation of radiology/histology of 46 archival midfacial sinonasal fibro-osseous lesions managed over three decades. A composite diagnosis was established based on clinicopathologic-radiologic correlation. Five levels of histological severity (including disorganized immature bone [DIB], cellular hemorrhagic stroma with giant cells [CHG], and absent osteoblastic rimming [AOR]) and five radiological grades of anatomical involvement were defined and correlated with clinical outcomes.

Results: Composite diagnosis did not correlate with histology or radiology alone, although histological and radiological levels correlated with each other. DIB, CHG, and AOR were more frequently observed in cases with orbital and maxillary involvement. Well-defined margins were more evident in lesions involving the alveolus and in bilateral disease, whereas ill-defined margins predominated near the optic nerve, pterygoids, and cribriform plate. Recurrence demonstrated a predilection for anterior (facial), inferior (palatal), and posterior (sphenoidal) extension, but not for superior or posterosuperior spread.

Conclusions: Neither histology nor radiology alone can reliably predict clinical behaviour or guide classification. Determinants of treatment planning include functional disability, aesthetic concerns, radiological-extent, and margin-status. Prognostic determinants include age, disease duration, aggressive-histologic features, and malignant transformation. Radiological level of involvement and clinical progression history remain key prognostic factors.