Positive Correlation of Hyams Histopathologic Grading in Esthesioneuroblastoma to PET/CT Enhancement and Survival Rates

Objectives: 1. To evaluate the prognostic value of Hyams histopathological grading of Esthesioneuroblastoma (ENB); 2. To compare Hyams grading with maximum standardized uptake value (SUV) of primary tumor or metastasis on preoperative positron emission tomography—computed tomography (PET/CT) imaging. Materials and Methods: Retrospective case–series report of all ENB patients treated at a single institution from October 15th, 2007 to June 15th, 2015. The main measures were Kadish stage, “Dulguerov TNM,” Hyams grade, disease-free survival, overall survival, and maximum SUV on PET/CT of primary tumor or metastasis. Regression statistical analysis was performed to compare PET/CT and Hyams grade. Kaplan-Meier survival analyses were also completed. Results: Between 2007 and 2015, 19 patients with Esthesioneuroblastoma (ENB) were evaluated and 16 were treated. Kadish staging at presentation was classified as: 1 Kadish A, 6 Kadish B, 9 Kadish C patients. “Dulguerov TNM” was: 1 T1, 6 T2, 3 T3, 6 T4 patients, with N0M0 in all. Hyams histopathological grading was: 2 Grade I, 8 Grade II, 6 Grade III, 0 Grade IV patients. The average age at presentation was 55 years (range 2–81 years). The mean follow-up was 45 months. PET/CT scan preoperatively was performed in 7/16. The SUV of the primary tumor site showed a median of 4.7 (range 2.4–12.3). All 16 patients underwent endonasal endoscopic resection; 5/16 (31%) also had a craniotomy. Three patients had multiple endoscopic procedures for tumor extirpation. Fifteen patients were treated with postoperative radiation to the primary site. Concomitant radiation was given to the neck in 13 patients. One patient had an ipsilateral neck dissection instead of radiation. Eleven patients received adjuvant cisplatin chemotherapy. One patient had persistent disease after radiation, identified 9 months after completion of treatment. 4/16 developed regional or distant disease: 4 with distant metastasis, 2 of which also had regional recurrence. These metastases occurred an average of 17 months after completion of radiation (range 26 days to 51 months). They were detected by PET/CT imaging in 2 patients (SUV 5.8 and 11), MRI in 1 patient, and SPECT scan in 1 patient. Of the patients with recurrence, one of two patients with regional recurrence had it discovered through a PET/CT scan showing SUV of 11.5; the one patient with persistent disease had an SUV of 5.1. Hyams grade I-II had an average SUV on preoperative PET/CT scan of 4.1 (SD 1.3