Role of middle turbinate biopsy in the diagnosis of fulminant invasive fungal rhinosinusitis

Objective: To determine the efficacy of middle turbinate biopsy in the diag nosis of fulminant invasive fungal rhinosinusitis, Study Design: Nonrandomi zed prospective study, Methods: Directed middle turbinate biopsy was perfor med in 25 patients suspected of having fulminant invasive fungal rhinosinus itis, All patients were immunocompromised and had fever of unknown origin, symptoms of rhinosinusitis, or both. Results: Six patients were found to ha ve fungal invasion on histopathological review (6 true-positive finding s), disease developed in 2 patients with negative results on biopsy (2 false-n egative findings), and disease never developed in 17 patients with negative results on biopsy (17 true-negative findings), resulting in an overall sen sitivity of 75% and a specificity of 100%. Conclusions: Middle turbinate bi opsy is a safe and effective method of making a timely diagnosis of fulmina nt invasive fungal rhinosinusitis. The added morbidity and cost of surgery can be avoided in the patient with a negative finding on biopsy. However, t he effect of earlier diagnosis on overall patient survival is unclear at pr esent,