10.14639/0392-100X-N2522
Objective.&nbsp;This study aimed to investigate the global research status, hot topics, and prospects in the field of sinonasal inverted papilloma (SNIP) through bibliometric analysis.Methods. The literature on SNIP was retrieved and downloaded from the Web of Science Core Collection from 2002 to 2021. The bibliometric and visualisation networks of SNIP were constructed using VOSviewer 1.6.18, CiteSpace 6.1. R2, and a bibliometric online analysis platform.Results. A total of 560 original articles about SNIP research were included, involving 2,457 authors from 610 institutions in 45 countries. The number of SNIP publications showed an overall rising trend, with an average annual output of 28 articles and almost 3 times as many articles published in 2020 as in 2002. The analysis of keyword burst detection indicated that EGFR mutation, malignant transformation and infection are emerging research hotspots. Moreover, EGFR mutation, KRAS mutation, malignant tumour, metallothionein 2a gene, pre-operative diagnosis, HPV-negative tumour, and expression were among the 11 key clusters of co-cited references.Conclusions. This study provided a comprehensive, systematic, and objective analysis and visualised knowledge map of SNIP over the past 2 decades. In particular, current hotspots and prospective trends in the field of SNIP have been identified. These results highlight the future direction of SNIP research for rhinologists.
text/xml
1827-675X
2522
en
Jinxiao Hou
http://creativecommons.org/licenses/by-nc-nd/4.0
ACTA Otorhinolaryngologica Italica
web of science core collection database
Global research on sinonasal inverted papilloma  over the past two decades: a bibliometric analysis
Text.Serial.Journal
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44
Rhinology
2023-12-29
2023-02-18
2024-04-23
2024-04-23
83-90
1
Jinxiao Hou
2024
10.14639/0392-100X-N2522
83
 Department of Hematology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui  Province, China. Corrisponding author - houjinxiao88@163.com 
1827-675X
web of science core collection database
en
90
Global research on sinonasal inverted papilloma  over the past two decades: a bibliometric analysis
https://www.actaitalica.it/article/download/2522/1066
44
ACTA OTORHINOLARYNGOLOGICA ITALICA 2024;44:83-90; doi: 10.14639/0392-100X-N2522




Rhinology


Global research on sinonasal inverted papilloma
over the past two decades: a bibliometric analysis
Dachuan Fan1*, Yongjun Zhu1*, Jianming Yang1, Jinxiao Hou2
1
  Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei,
Anhui Province, China; 2 Department of Hematology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui
Province, China
* D. Fan and Y. Zhu contributed equally to this work.



SUMMARY
Objective. This study aimed to investigate the global research status, hot topics, and pros-
pects in the field of sinonasal inverted papilloma (SNIP) through bibliometric analysis.
Methods. The literature on SNIP was retrieved and downloaded from the Web of Science
Core Collection from 2002 to 2021. The bibliometric and visualisation networks of SNIP
were constructed using VOSviewer 1.6.18, CiteSpace 6.1. R2, and a bibliometric online
analysis platform.
Results. A total of 560 original articles about SNIP research were included, involving 2,457
authors from 610 institutions in 45 countries. The number of SNIP publications showed
an overall rising trend, with an average annual output of 28 articles and almost 3 times as
many articles published in 2020 as in 2002. The analysis of keyword burst detection indi-
cated that EGFR mutation, malignant transformation and infection are emerging research
hotspots. Moreover, EGFR mutation, KRAS mutation, malignant tumour, metallothionein
2a gene, pre-operative diagnosis, HPV-negative tumour, and expression were among the 11
key clusters of co-cited references.
Conclusions. This study provided a comprehensive, systematic, and objective analysis and
visualised knowledge map of SNIP over the past 2 decades. In particular, current hotspots
and prospective trends in the field of SNIP have been identified. These results highlight the
future direction of SNIP research for rhinologists.
KEY WORDS: bibliometric analysis, research status, hot topics, sinonasal inverted
papilloma, web of science core collection database                                              Received: February 18, 2023
                                                                                                Accepted: July 15, 2023
                                                                                                Published online: December 29, 2023
Introduction
                                                                                                Correspondence
Sinonasal inverted papilloma (SNIP) is a benign epithelial neoplasm that com-                   Jinxiao Hou
monly occurs in the nasal cavity or paranasal sinuses, initially described by                   E-mail: houjinxiao88@163.com
Ward in 1854 1. SNIP is histologically characterised by endophytic growth of
the surface respiratory epithelium into underlying connective tissue stroma with-                 How to cite this article: Fan D, Zhu Y, Yang J, et
out involving the basement membrane 2. The occurrence of SNIP can lead to                         al. Global research on sinonasal inverted papillo-
                                                                                                  ma over the past two decades: a bibliometric anal-
recurrence and carries a risk of transformation into squamous cell carcinoma                      ysis. Acta Otorhinolaryngol Ital 2024;44:83-90.
(SCC). The primary causes of SNIP recurrence are the surgeon’s experience,                        https://doi.org/10.14639/0392-100X-N2522
tumour location and inadequate removal 3. It is essential to note that SNIP has
                                                                                                © Società Italiana di Otorinolaringoiatria
a rate of 7.1% for synchronous carcinoma and in 3.6% of cases develops into                     e Chirurgia Cervico-Facciale
metachronous carcinoma 4. Currently, no specific features have been identified
as significant predictors of multiple recurrences or malignancy. In general, radi-                             OPEN ACCESS
cal surgery with post-operative radiation is the preferred treatment for malignant              This is an open access article distributed in accordance with
                                                                                                the CC-BY-NC-ND (Creative Commons Attribution-Non-
SNIP. There are few studies that provide a comprehensive overview of research                   Commercial-NoDerivatives 4.0 International) license. The
trends in SNIP, including its aetiology, diagnosis and treatment strategies.                    article can be used by giving appropriate credit and mentio-
                                                                                                ning the license, but only for non-commercial purposes and
Bibliometric analysis serves as a crucial statistical method to analyse academ-                 only in the original version. For further information: https://
ic information and scientific outcomes of the medical literature on a selected                  creativecommons.org/licenses/by-nc-nd/4.0/deed.en




                                                                                                                                                          83
D. Fan et al.




research area over a given period using computational and          into the software. VOSviewer 1.6.18 (Leiden University,
visual analytic approaches. Unlike traditional systematic          Leiden, the Netherlands), CiteSpace 6.1. R2, 64-bit (Drexel
reviews and meta-analyses, bibliometric analysis can reveal        University, Philadelphia, PA, USA) and a bibliometric on-
both qualitative and quantitative aspects of a research topic      line analysis platform (http://bibliometric.com/) were used
from a systematic and intuitive level, exploring its longi-        to analyse co-cited articles, keywords, countries, institu-
tudinal and transversal characteristics, developments, and         tions, journals, authors and network features of keyword
multiple ramifications across various research fields 5. This      bursts, as well as to present the results visually.
analysis has been widely utilised in various medical spe-          Exported records were in “plain text” format with “full
cialties, including cerebrospinal fluid leak, allergic rhinitis,   records and citation references”, and were imported into
and chronic rhinosinusitis, to gain a deeper understanding         CiteSpace. CiteSpace, a bibliometric analysis visualisation
of pathogenesis, identify therapeutic alternatives, improve        software, was used to investigate institutional collaboration
prognosis and develop guidelines 6-8. However, bibliomet-          networks, detect co-cited references, explore keywords and
ric analysis related to SNIP has not been extensively con-         references with high citation bursts over time, and forecast
ducted.                                                            the research hotspots and emerging trends in this study. The
In this study, we aimed to systematically compile the avail-       parameters of CiteSpace were set as follows: time slicing
able literature on SNIP from 2002 to 2021, comprehen-              from 2002 to 2021, years per slice (1), term source (all se-
sively create collaboration networks and keyword clusters,         lection), node type (choose one at a time), links (strength:
and reveal emerging trends and hot spots to advance future         cosine; scope: within slices), selection criteria (the scale
research and clinical applications in the forthcoming years.       factor κ = 25), pruning (pathfinder, pruning sliced net-
To this end, we constructed the organic image of SNIP to           works, pruning the merged network), and visualisation
portray an overview from a historical standpoint, thereby
                                                                   (cluster view-static, show merged network). Additionally,
providing a new perspective for rhinologists to facilitate the
                                                                   the centrality score was analysed using CiteSpace. The cen-
formulation and administration of scientific research.
                                                                   trality score assesses the relevance of network nodes, with
                                                                   the greater centrality being a more important node. On the
Materials and methods                                              network visualisation map, the size of the nodes represents
Data source and search strategy                                    the frequency, whereas the different colours of the nodes
The bibliometric study was carried out using the Science           represent different years. The lines between nodes imply
Citation Index Expanded (SCI-E) and the Social Sciences            cooperation or co-occurrence or co-referencing relation-
Citation Index (SSCI) of the Web of Science Core Collec-           ships.
tion (WoSCC). We performed a thorough search of the Wo-            Similarly, VOSviewer was employed to visually illustrate the
SCC database for relevant publications from 2002 to 2021           co-occurrence networks of authors and keywords, classify
and included only original articles. The search terms that         keywords into different clusters, and construct density maps.
we used in the WoSCC were as follows: Topic = (“nasal              Cluster analysis of research hotspots can be visualised, and the
inverted papilloma” OR “sinonasal inverted papilloma”)             keyword co-occurrence network can identify emerging trends.
AND Language = English. To avoid possible bias from fre-
quent updated databases, all data downloads and system-            Results
atic literature searches were documented and completed on
October 1, 2021. The detailed search procedure is shown in         Annual outputs and growth trends
Figure 1A. Two researchers independently undertook data            In total, 560 original articles about SNIP were published
analysis. Any divergences were resolved through negotia-           from 2002 to 2021. Despite some fluctuations between
tion or by seeking the help of a third reviewer to reach an        2012 to 2016, research outputs on SNIP exhibited an
excellent consensus. The full records of data were docu-           overall growing trend from 2002 to 2021, with almost
mented and screened for inclusion based on titles, journals,       three times as many articles published in 2020 as in 2002
abstracts, keywords, authors, countries/regions, institu-          (Fig. 1B). The annual average number of publications was
tions, references, Hirsch index (H-index) in 2021 and total        28. The number of publications per year has exceeded 20
citations. The H-index is considered an important indicator        since 2006. The number of publications reached a peak of
of the scientific impact of an author’s publications.              47 in 2020, exceeding 40 for the first time. A growth trend
                                                                   model (R2 = 0.7716) indicated that the volume of literature
Analysis tool                                                      on SNIP would continue to increase and show potential in
WoSCC data were converted to text before being imported            the near future.



84
                                                           Global research on sinonasal inverted papilloma over the past two decades: a bibliometric analysis




Distribution of countries/regions and institutions                                University ranked first in terms of the centrality score
The publications in the field were distributed among 610                          (0.02) with an H-index of 25. The author with the high-
institutions from 45 countries. Twenty-four countries and                         est H-index of 68 was David W. Kennedy, followed by
573 institutions each contributed at least five articles. The                     James N. Palmer.
top 10 contributing countries are listed in Table I. Most
publications came from the United States (n = 139), fol-                          Cluster analysis of keyword co-occurrence
lowed by China (n = 88), Japan (n = 53), South Korea                              related to research hotspots
(n = 45) and Italy (n = 44). The United States was the most                       In total, 1,598 different relevant keywords were extracted
productive country, publishing > 24% of the studies. The                          from 560 articles. A network map was generated for key-
centrality score indicates the relative importance of nodes                       words with more than 5 occurrences, which includes 184
in a network. Higher centrality in a collaborative network                        terms in the map (Fig. 2A). In the map, the high-frequency
determines more frequent cooperation. The United States                           keywords were “inverted papilloma” (n = 294), “paranasal
(0.28) had the highest centrality, closely followed by Italy                      sinuses” (n = 149), “management” (n = 146), “nasal cavity”
(0.27), China (0.16) and Canada (0.16). Table II revealed                         (n = 99), “surgery” (n = 98), “recurrence” (n = 74), “head”
the top 10 institutions that published the highest number                         (n = 73), “sinonasal inverted papilloma” (n = 72), “nose”
of articles on SNIP from 2002 to 2021, including Capital                          (n = 63), and “expression” (n = 62). The circle size repre-
                                                                                  sented the number of keyword occurrences. Terms associ-
Medical University (n = 26), Fudan University (n = 15),
and Sun Yat-sen University (n = 9) in China. The universi-
ties with the highest centrality score were the University
                                                                                  Table I. Ranking of the top 10 countries that have published the highest
of Pennsylvania (0.09) in the United States, followed by                          numbers of articles on SNIP from 2002 to 2021.
South Korea’s Pusan National University (0.05).                                    Rank        Article counts       Centrality score        Country
                                                                                  1                 139                  0.28                  USA
Contributions of authors
                                                                                  2                 88                   0.16                 China
We found that 2457 authors published articles on SNIP
                                                                                  3                  53                  0.06                 Japan
from 2002 to 2021.Table III lists the top 10 most produc-
                                                                                  4                  45                  0.01              South Korea
tive authors in terms of the number of published papers.
                                                                                  5                  44                  0.27                  Italy
Luo Zhang and Chengshuo Wang of Capital Medical
                                                                                  6                  27                  0.07               Germany
University (13 publications with 142 citations; 13 pub-
                                                                                  7                  22                  0.16                Canada
lications with 135 citations, respectively) had the most
                                                                                  8                  20                  0.02                France
published manuscripts, followed by James N. Palmer of
the University of Pennsylvania (11 publications; 210 ci-                          9                  17                  0.00                   UK
tations) with an H-index of 48. Dehui Wang of Fudan                               10                 15                  0.00                Poland



A                                                                             B




Figure 1. Frame flow diagram of search strategy (A) and trends in the number of publications (B) of SNIP research from 2002 to 2021.



                                                                                                                                                         85
D. Fan et al.




Table II. Ranking of the top 10 published institutions on SNIP research from 2002 to 2021.
 Rank                  Article count                 Centrality                       Institution                            Country
                                                       score
 1                           26                       0.03                     Capital Medical University                   China
 2                           15                       0.02                         Fudan University                         China
 3                           12                       0.05                     Pusan National University                 South Korea
 4                           11                       0.09                     University of Pennsylvania                    USA
 5                            9                       0.00                        Hokkaido University                      Japan
 6                            9                       0.00                     Medical University of Lodz                  Poland
 7                            9                       0.00                      Sun Yat-sen University                      China
 8                            9                       0.00                       University of Insubria                      Italy
 9                            8                       0.01                         Yonsei University                     South Korea
 10                           8                       0.00                      University of California                     USA



ated with similar research topics were grouped into the same                     Detection of keyword bursts
catalogue. The keywords were classified into five main clus-                     The keywords with the strongest citation bursts can rep-
ters: the purple cluster was related to the anatomy of the na-                   resent the previous or current research hotspots, predict
sal cavity and sinuses, the red cluster was associated with the                  the future development trends of the field, and highlight
basic research of malignant transformation, the blue cluster                     potential hotspots in a discipline. The chronology is dis-
was linked to clinical diagnosis, the green cluster pertained                    played by a blue timeline that spans across years. A red
to surgical treatment, and the yellow cluster was primarily                      segment denotes the start year, end year, and time span of
associated with the risk factors for recurrence (Fig. 2A).                       a burst. Keyword bursts between 2002 and 2021 were de-
                                                                                 tected based on an examination of 560 articles included in
We next coded different keywords by colour in order of
                                                                                 the WoSCC database (Fig. 2C). In the early stage, “nose”
time in the corresponding literature (Fig. 2B). The key-
                                                                                 had the strongest burst (strength = 12.89). “EGFR muta-
words in blue appeared earlier, and the keywords in yellow
                                                                                 tion” has emerged in the last three years (2018-2021) with a
appeared later. The early research mainly focused on the                         strength of 6.64, followed by “recurrence” (strength = 5.93)
themes of diagnosis and gradually developed into surgical                        and “meta-analysis” (strength = 3.88). Notably, the bursts
treatment. Yellow-green colours represent the most recent                        of “EGFR mutation”, “malignant transformation” and “in-
research topics, and the representative keywords were “re-                       fection” are still ongoing.
currence”, “classification”, “risk factor”, “EGFR mutation”
and “malignant transformation”. The results showed recur-                        Analysis of co-cited references
rence and malignant transformation might become future                           From 560 articles, 7797 cited references were submitted
research emphases.                                                               for analysis of co-citation correlation, and a cluster network


Table III. Ranking of the top 10 most published authors on SNIP research from 2002 to 2021.
 Rank                   Author                 Article              Centrality          Total number        Average number             H-index
                                               count                  score              of citations         of citations
 1                    Zhang L                    13                     0.01                    142              10.9                    45
 2                    Wang CS                    13                     0.01                    135              10.4                    26
 3                   Palmer JN                   11                     0.01                    210              19.1                    48
 4                     Roh HJ                    10                     0.01                    308              30.8                    24
 5                  Danilewicz M                  9                     0.00                     50               5.6                    13
 6                  Castelnuovo P                 8                     0.00                    608              76.0                    38
 7                    Batra PS                    8                     0.00                    253              31.6                    34
 8                    Wang DH                     8                     0.02                     85              10.6                    25
 9                   Adappa ND                    8                     0.01                     77               9.6                    33
 10                 Kennedy DW                    7                     0.01                     98              14.0                    68




86
                                                          Global research on sinonasal inverted papilloma over the past two decades: a bibliometric analysis




A                                                  B                                                    C




Figure 2. Co-occurrence analysis of global research on SNIP based on the WoSCC database from 2002 to 2021. (A) Mapping of keywords in the research field.
(B) Distribution of keywords according to the chronological order of appearance. (C) Keywords with the strongest citation bursts in SNIP research.


diagram was created based on the results. The nodes of the                     dom, and Poland also published many papers. However,
network represent references. The literature co-citation net-                  they may have less collaboration with other countries, as
work consisted of 80 nodes and 146 links (Fig. 3A). The                        shown by their relatively low centrality scores. The coun-
node size is proportional to the total number of co-citations                  tries with lower rates of cooperation should strengthen
of the article. The node colour represents the cited time of                   their international collaborations, especially with those
reference. The nodes with a thick purple ring around them                      leading nations, in order to accelerate their progress in
(Cannady 9 and Mirza 4) were used to connect the stages of                     SNIP research.
the growth of a field, which implied to be the turning points                  Herein, we focused on further detection of the co-occur-
and hubs of a domain and play an important undertaking                         rence and burst analysis of major keywords. We performed
role in the entire internal network. The red rings (Wang                       generation of clustering based on co-occurrence informa-
10
   and Udager 11) indicated to be explosive citations. By                      tion of main keywords. According to similar research sub-
identifying the crucial keywords from the cited references,                    jects under the same catalogue, we grouped them into five
we could detect the research hotspots. “EGFR mutation”,                        categories: anatomy, pathogenesis, diagnosis, treatment,
“KRAS mutation”, “malignant tumour”, “metallothionein                          and recurrence of SNIP. Based on keyword bursts in the last
2a gene”, “pre-operative diagnosis”, “HPV-negative tu-                         five years, we discussed the relationship between classifi-
mour”, and “expression” were among the 11 key clusters                         cation staging systems and recurrence of SNIP. At the same
of co-cited references (Fig. 3B).                                              time, most current studies on malignant transformation of
                                                                               SNIP have expressed concerns about the research subjects
                                                                               and quality, and so it is meaningful to make a general sum-
Discussion
                                                                               mary based on them. Based on the above discussion of two
This is the first application of quantitative and qualita-                     clusters, we gained a profound understanding of present
tive bibliometric methods to SNIP research. It involved                        concerns and research hotspots in this field.
560 research papers retrieved from WoSCC database.                             Although endoscopic sinus surgery has been considered
Over the past 20 years, nearly a quarter of all articles                       a treatment of choice for most SNIP cases, better treat-
were from the United States, which greatly promoted the                        ment planning should account for the clinical stage which
advancement of SNIP research. In addition, the Univer-                         is closely associated with post-operative outcomes. In
sity of Pennsylvania had the strongest partnerships with                       2000, Krouse first proposed a staging system that incor-
other institutions, which were beneficial for those institu-                   porated both the extent and volume of tumour, which has
tions that rarely communicate with each other. The United                      been widely adopted over the last few decades 12. However,
States demonstrated the most intensive collaboration and                       several studies found that recurrence rates did not differ
the highest centrality to other countries. Moreover, an in-                    significantly between different stages of the Krouse stag-
creasing number of scholars worldwide showed interest in                       ing system 13,14. Subsequently, other grading systems have
SNIP research according to the growth curve. This trend                        been improved over time 9,15-17. Nakayama and colleagues
partly implied a mature medical research and health en-                        revealed that Meng et al.’s origin site-based staging sys-
vironment in these countries and the critical need for ef-                     tem maintained a proportional hazard ratio for all follow-
ficient SNIP research. South Korea, France, United King-                       up durations without crossing the survival curve and had a



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D. Fan et al.




A                                                                      B




Figure 3. Co-cited references map (A) and clustered map of co-cited references (B) on SNIP research from 2002 to 2021.


good correlation with recurrence rate 18. Meng et al. also                    greatest overall average effect size of common high-risk
recommended optimal surgical strategies according to their                    subtypes 26,27. Moreover, EGFR mutations have also been
staging system and demonstrated a total recurrence rate of                    implicated in the pathogenesis of SNIP-associated SCC,
6.4% involving 675 SNIP patients in a subsequent prospec-                     but their relationship to HPV status is unclear. Identi-
tive multicentre study, which was much lower compared                         cal EGFR genotypes were found in matched pairs of SNIP
with several earlier large sample studies 17. Clearly, it is                  and SNIP-associated SCC. Treatment of SNIP-associated
very important to accurately predict where tumours origi-                     carcinoma cells with irreversible EGFR inhibitors resulted
nate before surgery. The osteitis/neosteogenesis signs on                     in the inactivation of EGFR signaling and growth inhibi-
computed tomography combined with convoluted cerebri-                         tion 22. Conversely, EGFR mutations characterised SNIP
form patterns reverse-tracing method on T2- or enhanced                       with a lower risk of developing into SCC 28. As a result,
T1-weighted images have been employed to predict and                          further research into the risk of malignant progression in
identify original site of SNIP 19,20. The explanations for                    relation to SNIP is required.
underlying pathological mechanisms involved the differ-
ent distributions of cellularity, vascularity and claudin-5                   Limitations
expression in microvessels between original site and pe-                      This study had several limitations in using bibliometric
riphery of SNIP 21.                                                           analysis for research on SNIP. First, we only used data from
Despite its tendency for malignant transformation, predict-                   the SCI-E and SSCI of WoSCC between 2002 and 2021,
ing which patients with SNIP will transform into SCC is                       and did not include data from other relevant search engines
difficult as there is no correlation between clinical vari-                   and other time periods. Some publications from other da-
ables, such as the number of SNIP local recurrences or                        tabases might have been missed. However, the WoSCC
surgeries, and the subsequent progression to carcinoma 22.                    database is one of the most extensive and well-recognised
Different molecular mechanisms are suspected to play cru-                     global resources and has been extensively applied for the
cial roles in this process. Previously, SNIP-associated SCC                   retrieval of natural science publications. The overall situa-
had significantly lower rates of positive margins, advanced                   tion and general trend in SNIP treatment over the past two
T classification and distant metastasis compared to de no-                    decades were fully demonstrated. Second, the considera-
vo SCC 23,24. These findings suggested the involvement of                     tion of articles published in English only may have gener-
distinct molecular pathways in oncogenesis. Several stud-                     ated a linguistic bias in our analyses, even if English is the
ies revealed that there seemed to be a strong association                     most commonly used language to publish academic docu-
between infection with high-risk HPV subtypes and ma-                         ments worldwide. Finally, the omission of books/chapters/
lignant transformation of SNIP 25-27. HPV-18 showed the                       letters may not fully represent all publications about SNIP.



88
                                                 Global research on sinonasal inverted papilloma over the past two decades: a bibliometric analysis




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mittee of the Second Affiliated Hospital of Anhui Medical                  58. https://doi.org/10.1002/lary.26222
University (approval number/protocol number YX2021-                   14
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cedures being performed in accordance with the require-               15
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Written informed consent was obtained from each partici-                   of sinonasal inverting papilloma. Laryngoscope 2001;111:1395-1400.
pant/patient for study participation and data publication.                 https://doi.org/10.1097/00005537-200108000-00015
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Data availability statement                                                sinonasal inverted papilloma for application to endoscopic sinus sur-
                                                                           gery. Head Neck 2019;41:440-447. https://doi.org/10.1002/hed.25435
The raw datasets supporting this study’s findings can be              18
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found in the article/supplementary material online. Further                staging systems for sinonasal inverted papilloma. Am J Rhinol Al-
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