Clinical-Cytological-Grading and phenotyping in patients with chronic rhinosinusitis with nasal polyps: the relevance in clinical practice


  • Matteo Gelardi Department of Otolaryngology, University of Foggia, Italy.
  • Giuseppe Porro Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Italy.
  • Vitaliano Quaranta Pulmonology Unit, Ospedale Di Venere, Bari, Italy.
  • Nicola Quaranta Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Italy.
  • Michele Cassano Department of Otolaryngology, University of Foggia, Italy.
  • Giorgio Ciprandi | Allergist consultant, Casa di Cura Villa Montallegro, Genoa, Italy.
  • *Italian Study Group on CRSwNP


Chronic rhinosinusitis (CRS) includes two main phenotypes: without nasal polyps (CRSsNP) and with nasal polyps (CRSwNP). CRSwNP may be associated with comorbidity, mainly concerning asthma, aspirin intolerance, and allergy. CRSwNP patients may also be evaluated by clinical-cytological grading (CCG). The current study investigated the prevalence and characteristics of the different CCG and phenotypes in CRSwNP outpatients examined in clinical practice. This retrospective cross-sectional study enrolled 791 consecutive CRSwNP outpatients (424 males, mean age 48.8 years). In the total population, asthma was a common comorbidity (30.8%) as well as aspirin intolerance (24.8%), and allergy (50.8%). As concerns CCG-grading, 210 (26.5%) outpatients had low-grade, 366 (46.3%) medium, and 215 (27.2%) high. As regards cytological phenotypes, 87 (11%) had neutrophilic type, 371 (46.3%) eosinophilic, 112 (14.2%) mast cell, and 221 (27.9%) mixed. High-grade CCG was significantly associated with more frequent asthma, aspirin intolerance, allergy, recurrent surgery, and mixed cytological phenotype. Low-grade CCG was characterized by fewer comorbidities and operations, and neutrophilic phenotype. Therefore, the present study confirmed that CCG is a useful tool in the management of outpatients with CRSwNP. CRSwNP is frequently associated with asthma, aspirin intolerance, and allergy comorbidity. High-grade CCG is frequently characterized by a mixed cytological phenotype, thus, by more severe progress. These real-world outcomes underline that CRSwNP deserves adequate attention for careful management and optimal identification of the best-tailored therapy; CCG and cytological phenotyping could be fruitful tools in clinical practice. Asthma and aspirin intolerance should be adequately investigated in all CRS patients.



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Pneumology - Original Articles
chronic rhinosinusitis with nasal polyps, asthma, clinical-cytological-grading, cytological phenotype, comorbidity, real-world
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How to Cite
Gelardi, Matteo, Giuseppe Porro, Vitaliano Quaranta, Nicola Quaranta, Michele Cassano, Giorgio Ciprandi, and *Italian Study Group on CRSwNP. 2020. “Clinical-Cytological-Grading and Phenotyping in Patients With Chronic Rhinosinusitis With Nasal Polyps: The Relevance in Clinical Practice”. Monaldi Archives for Chest Disease 90 (2).

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