Nasal cytology as a reliable non-invasive procedure to phenotype patients with type 2 chronic rhinosinusitis with nasal polyps

Giovanni Paoletti; Luca Malvezzi; Anna Maria Riccio; Desideria Descalzi; Francesca Pirola; Elena Russo; Laura De Ferrari; Francesca Racca; Sebastian Ferri; Maria Rita Messina; Francesca Puggioni; Emanuele Nappi; Diego Bagnasco; Frank Rikki Canevari; Fabio Grizzi; Giuseppe Mercante; Giuseppe Spriano; Giorgio Walter Canonica; Enrico Heffler

doi:10.1016/j.waojou.2022.100700

Nasal cytology as a reliable non-invasive procedure to phenotype patients with type 2 chronic rhinosinusitis with nasal polyps

World Allergy Organ J. 2022 Oct 18;15(11):100700. doi: 10.1016/j.waojou.2022.100700. eCollection 2022 Nov.

Authors

Giovanni Paoletti^{1

2}, Luca Malvezzi^{2

3}, Anna Maria Riccio^{4

5}, Desideria Descalzi^{1

2}, Francesca Pirola³, Elena Russo³, Laura De Ferrari^{4

5}, Francesca Racca¹, Sebastian Ferri¹, Maria Rita Messina^{1

2}, Francesca Puggioni^{1

2}, Emanuele Nappi^{1

2}, Diego Bagnasco^{4

5}, Frank Rikki Canevari^{6

7}, Fabio Grizzi⁸, Giuseppe Mercante^{2

3}, Giuseppe Spriano^{2

3}, Giorgio Walter Canonica^{1

2}, Enrico Heffler^{1

2}

Affiliations

¹ Personalized Medicine, Asthma and Allergy, IRCCS Research Hospital, Rozzano, MI, Italy.
² Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy.
³ Department of Otorhinolaryngology and Head and Neck Surgery, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy.
⁴ Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, Genova, Italy.
⁵ Department of Internal Medicine (DIMI), University of Genova, Genova, Italy.
⁶ Othorinolaryngology, IRCCS Policlinico San Martino, Genova, Italy.
⁷ Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genova, Italy.
⁸ Department of Immunology and Inflammation, IRCCS Humanitas Research Hospital, Rozzano, 20089, Milan, Italy.

Abstract

Background: The identification of type-2 inflammation in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) acquires a crucial role in the endotypization needed for selecting patients for biological drugs targeting type-2 inflammation: to date, the parameters used include systemic and histological biomarkers. The aim of this study was to investigate whether nasal cytology could identify type-2 inflammation in patients with CRSwNP.

Methodology: Thirty-three consecutive patients with CRSwNP underwent nasal cytology sampling at the level of the lower nasal turbinate, and of the polypoid tissue, and surgical polyp tissue sample was collected. The cellularity of the 3 collected samples were compared.

Results: Mean nasal polyp tissue, nasal polyps cytology and inferior turbinate cytology eosinophils counts were 43.7 ± 39.6 cells/HPF, 32.8 ± 44.7 cells/HPF and 27.6 ± 58.0 cells/HPF respectively with inferior turbinate cytology eosinophils significantly lower than nasal polyp tissue count (p = 0.007). Both mean nasal polyps cytology eosinophils and mean inferior turbinate cytology eosinophils were significantly higher in patients with type-2 CRSwNP (52.5 ± 67.0 cells/HPF vs 12.2 ± 17.3 cells/HPF, p = 0.012, and 32.0 ± 62.1 cells/HPF vs 2.9 ± 2.9 cells/HPF, p = 0.020 respectively).

Conclusions: Nasal cytology is suitable tool for assessing local biomarkers of type-2 inflammation in CRSwNP.

Keywords: Biomarkers; Chronic rhinosinusitis with nasal polyps; Diagnostic tool; Nasal cytology; Type-2 inflammation.