Skip to main content
SpringerLink
Log in

Diagnostic performance of nasal cytology

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Nasal pathologies are characterized by a symptomatology that hardly allows to distinguish allergic rhinitis (AR), non-allergic rhinitis (NAR), and chronic rhinosinusitis (CRS). Nasal cytology (NC) has shown increasing importance in helping the clinician to differentiate the various phenotypes of rhinitis. NC allows us to evaluate nasal cellularity by distinguishing AR and various types of NAR. The objective of the study is to assess the diagnostic performance of the NC by evaluating its sensitivity, specificity, and predictive value.

Methods

We recruited 387 patients with persistent rhinitis symptoms, and nasal cytology was performed. The rhinocytogram was obtained by reading for fields and the cellular count was made using quantitative and semi-quantitative grading together.

Results

Two hundred and fifteen patients (55.5%; 38 had acute rhinitis, 24 acute sinusitis, 153 chronic rhinosinusitis) out of 387 referred nasal symptoms. Cytological specimen showed a mean of 94 ± 4% ciliated cells, 29 ± 0.2% mucinous cells, 16 ± 0.1% neutrophils, 11 ± 0.08% eosinophils, 4 ± 0.03 lymphocytes, 4 ± 0.03% mast cells, and 4 ± 0.01% other cells. NC was positive in 271 cases (70%). After revision of medical history, 153 patients (39%) were considered positive for NAR. Test sensibility was 100% (95% CI 97–100), specificity was 49.6% (95% CI 43–56%). Positive predictive value (PPV) was 56% (95% CI 50–62%), and negative predictive value (NPV) was 100% (95% CI 96–100%). The positive likelihood ratio was 1.98 (95% CI 1.75–2.25). Accuracy of the test was 69.5% (95% CI 64.6–74.0%).

Conclusion

Our data showed ability to identify the true-positive patients with NAR but a low ability to identify the true-negative patients, with a global accuracy of 69.5%.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Fokkens WJ, Lund VJ, Hopkins C et al (2020) European position paper on rhinosinusitis and nasal polyps 2020. Rhinology 58(Suppl S29):1–464. https://doi.org/10.4193/Rhin20.600

    Article  PubMed  Google Scholar 

  2. Frati F, Incorvaia C, Cavaliere C, Di Cara G, Marcucci F, Esposito S, Masieri S (2018) The skin prick test. J Biol Regul Homeost Agents 32(1 Suppl 1):19–24

    CAS  PubMed  Google Scholar 

  3. Savi E, Peveri S, Cavaliere C, Masieri S, Montagni M (2018) Laboratory tests for allergy diagnosis. J Biol Regul Homeost Agents 32(1 Suppl 1):25–28

    CAS  PubMed  Google Scholar 

  4. Koskinen A, Numminen J, Markkola A et al (2018) Diagnostic accuracy of symptoms, endoscopy, and imaging signs of chronic rhinosinusitis without nasal polyps compared to allergic rhinitis. Am J Rhinol Allergy 32(3):121–131. https://doi.org/10.1177/1945892418762891

    Article  CAS  PubMed  Google Scholar 

  5. Brożek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, Brignardello-Petersen R, Canonica GW, Casale T, Chavannes NH, Correia de Sousa J, Cruz AA, Cuello-Garcia CA, Demoly P, Dykewicz M, Etxeandia-Ikobaltzeta I, Florez ID, Fokkens W, Fonseca J, Hellings P et al (2017) Allergic rhinitis and its impact on Asthma (ARIA) guidelines—2016 revision. J Allergy Clin Immunol 140(4):950–958. https://doi.org/10.1016/j.jaci.2017.03.050

    Article  PubMed  Google Scholar 

  6. Hansel FK (1934) Observations on the cytology of the secretions in allergy of the nose and paranasal sinuses. J Allergy 5:357–366

    Article  Google Scholar 

  7. Meltzer EO, Jalowayski AA (2018) Nasal cytology in clinical practice. Am J Rhinol 2:47–54

    Article  Google Scholar 

  8. Gelardi M, Cavaliere C, Jannuzzi L (2018) Nasal cytology. J Biol Regul Homeost Agents 32(1 Suppl 1):37–40

    CAS  PubMed  Google Scholar 

  9. Waecker NJ Jr, Shope TR, Weber PA, Buck ML, Domingo RC, Hooper DG (1993) The rhino-probe nasal curette for detecting respiratory syncytial virus in children. Pediatr Infect Dis J 12(4):326–329. https://doi.org/10.1097/00006454-199304000-00012

    Article  PubMed  Google Scholar 

  10. Gelardi M, Iannuzzi L, Quaranta N, Landi M, Passalacqua G (2016) NASAL cytology: practical aspects and clinical relevance. Clinical Exp Allergy 46(6):785–792. https://doi.org/10.1111/cea.12730

    Article  CAS  Google Scholar 

  11. Canakcioglu S, Tahamiler R, Saritzali G, Alimoglu Y, Isildak H, Guvenc MG, Acar GO, Inci E (2009) Evaluation of nasal cytology in subjects with chronic rhinitis: a 7-year study. Am J Otolaryngol 30(5):312–317. https://doi.org/10.1016/j.amjoto.2008.06.015

    Article  PubMed  Google Scholar 

  12. Incorvaia C, Cavaliere C, Frati F, Masieri S (2018) Allergic rhinitis. J Biol Regul Homeost Agents 32(1 Suppl 1):61–66

    CAS  PubMed  Google Scholar 

  13. Di Lorenzo G, Pacor ML, Amodio E et al (2011) Differences and similarities between allergic and nonallergic rhinitis in a large sample of adult patients with rhinitis symptoms. Int Arch Allergy Immunol 155(3):263–270. https://doi.org/10.1159/000320050

    Article  CAS  PubMed  Google Scholar 

  14. Jacobs RL, Freedman PM, Boswell RN (1981) Nonallergic rhinitis with eosinophilia (NARES syndrome). Clinical and immunologic presentation. J Allergy Clin Immunol 67(4):253–262. https://doi.org/10.1016/0091-6749(81)90019-1

    Article  CAS  PubMed  Google Scholar 

  15. Gelardi M, Incorvaia C, Passalacqua G, Quaranta N, Frati F (2011) The classification of allergic rhinitis and its cytological correlate. Allergy 66(12):1624–1625. https://doi.org/10.1111/j.1398-9995.2011.02741.x

    Article  CAS  PubMed  Google Scholar 

  16. Ciofalo A, Pasquariello B, Iannella G, Manno A, Angeletti D, Gulotta G, Pace A, Magliulo G (2019) The role of nasal cytology in the diagnosis of allergic and non-allergic rhinitis in adult and children. Eur Rev Med Pharmacol Sci 23(12):5065–5073. https://doi.org/10.2635/eurrev_201906_18170

    Article  CAS  PubMed  Google Scholar 

  17. Topal E, Bakirtas A, Yılmaz O, Karagöl IH, Arslan U, Arga M, Demirsoy MS, Turktas I (2014) Predictive factors to differentiate between allergic and nonallergic rhinitis in children. Int Forum Allergy Rhinol 4(6):447–452. https://doi.org/10.1002/alr.21312

    Article  PubMed  Google Scholar 

  18. Chiang WC, Chen YM, Tan HK, Balakrishnan A, Liew WK, Lim HH, Goh SH, Loh WY, Wong P, Teoh OH, Goh A, Chay OM (2012) Allergic rhinitis and non-allergic rhinitis in children in the tropics: prevalence and risk associations. Pediatr Pulmonol 47(10):1026–1033. https://doi.org/10.1002/ppul.22554

    Article  PubMed  Google Scholar 

  19. Heffler E, Landi M, Caruso C, Fichera S, Gani F, Guida G, Liuzzo MT, Pistorio MP, Pizzimenti S, Riccio AM, Seccia V, Ferrando M, Malvezzi L, Passalacqua G, Gelardi M (2018) Nasal cytology: methodology with application to clinical practice and research. Clin Exp Allergy 48(9):1092–1106. https://doi.org/10.1111/cea.13207

    Article  CAS  PubMed  Google Scholar 

  20. Magliulo G, Iannella G, Ciofalo A, Polimeni A, De Vincentiis M, Pasquariello B, Montevecchi F, Vicini C (2019) Nasal pathologies in patients with obstructive sleep apnoea. Acta Otorhinolaryngol 39(4):250–256. https://doi.org/10.1463/0392-100X-2173

    Article  CAS  Google Scholar 

  21. Armitage P, Berry G, Matthews JNS (2002) Statistical methods in medical research. Wiley, Hoboken

    Book  Google Scholar 

  22. Mallett S, Halligan S, Thompson M, Collins GS, Altman DG (2012) Interpreting diagnostic accuracy studies for patient care. BMJ (Clin Res Ed) 345:e3999. https://doi.org/10.1136/bmj.e3999

    Article  Google Scholar 

  23. Diaz-Vazquez C, Torregrosa-Bertet MJ, Carvajal-Urueña I et al (2009) Accuracy of ImmunoCAP rapid in the diagnosis of allergic sensitization in children between 1 and 14 years with recurrent wheezing: the IReNE study. Pediatr Allergy Immunol 20(6):601–609. https://doi.org/10.1111/j.1399-3038.2008.00827.x

    Article  PubMed  Google Scholar 

  24. Traiyan S, Manuyakorn W, Kanchongkittiphon W, Sasisakulporn C, Jotikasthira W, Kiewngam P, Kamchaisatian W, Benjaponpitak S (2021) Skin prick test versus phadiatop as a tool for diagnosis of allergic rhinitis in children. Am J Rhinol Allergy 35(1):98–106. https://doi.org/10.1177/1945892420938300

    Article  PubMed  Google Scholar 

  25. Wise SK, Lin SY, Toskala E et al (2018) International consensus statement on allergy and rhinology: allergic rhinitis. Int Forum Allergy Rhinol 8(2):108–352. https://doi.org/10.1002/alr.22073

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This research received no external funding.

Author information

Authors and Affiliations

  1. Department of Sense Organs, Sapienza University, Rome, Italy

    Andrea Ciofalo, Giancarlo Altissimi & Antonio Greco

  2. Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy

    Carlo Cavaliere, Marco de Vincentiis & Simonetta Masieri

  3. Cardiac/Pulmonary Rehabilitation, ASST Pini-CTO, Milan, Italy

    Cristoforo Incorvaia

  4. Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Heidelberg, Germany

    Michaela Plath

  5. Medicine and Surgery Department, University of Parma, Parma, Italy

    Erminia Ridolo & Francesco Pucciarini

Authors
  1. Andrea Ciofalo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carlo Cavaliere
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cristoforo Incorvaia
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michaela Plath
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Erminia Ridolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Francesco Pucciarini
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Giancarlo Altissimi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Antonio Greco
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Marco de Vincentiis
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Simonetta Masieri
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization, methodology, investigation: AC, SM, and CC. Formal analysis: ER, FP, AG, MDV, and CI. Writing—original draft preparation: CC, MP, and CI. Writing—review and editing: AC, SM, MP, AG, and MDV.

Corresponding author

Correspondence to Carlo Cavaliere.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Ethics and consent

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Institutional Review Board, informed consent was obtained from all subjects involved in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ciofalo, A., Cavaliere, C., Incorvaia, C. et al. Diagnostic performance of nasal cytology. Eur Arch Otorhinolaryngol 279, 2451–2455 (2022). https://doi.org/10.1007/s00405-021-07044-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-021-07044-5

Keywords

Search

Navigation