Role of Nasal Nitric Oxide in the Diagnosis of Epithelial Remodeling Types of Nasal Polyps

Objective: The aim of this study is to investigate the clinical application value of exhaled nasal nitric oxide (nNO) in the pathological diagnosis and classification of epithelial remodeling in nasal polyps (NP). Methods: The differences between the nNO levels in patients with NP exhibiting different types of epithelial remodeling and the correlations between nNO and clinical data were retrospectively analyzed. The diagnostic value of nNO in NP was evaluated using receiver operating characteristic curves. Results: The levels of nNO in the control group were found to be significantly higher than those in the epithelial hyperplasia, goblet cell hyperplasia, and squamous metaplasia groups (p=0.001, p=0.001, p=0.02). Furthermore, the levels were found to be significantly higher in the squamous metaplasia group than those in the epithelial hyperplasia and goblet cell hyperplasia groups (p=0.025, p=0.018). The percentage and count of eosinophils in peripheral blood in the goblet cell hyperplasia group were significantly higher than in the control group (p=0.001). nNO levels were negatively correlated with the ethmoid-to-maxillary computed tomography score ratio (E/M ratio) and Lund-Mackay score (L-M score) in the epithelial hyperplasia group and the goblet cell hyperplasia group (r=-0.518, p<0.05; r=-0.640, p<0.01; r=-0.421, p<0.01; r=-0.599, p<0.001, respectively). Similarly, a negative correlation was identified between nNO levels and the L-M score in the squamous metaplasia group (r=-0.612, p<0.01). nNO levels exhibited moderate diagnostic value in differentiating non-chronic sinusitis patients from epithelial hyperplasia, goblet cell hyperplasia, and squamous metaplasia [area under the curve (AUC) =0.898, p<0.001; AUC=0.882, p<0.001; AUC=0.720, p=0.025, respectively]. Conclusion: nNO has been shown to have significant clinical value in the preliminary pathological diagnosis and prediction of NP lesions with nasal epithelial hyperplasia, goblet cell hyperplasia, and squamous metaplasia.