Lund–Mackay and modified Lund–Mackay score for sinus surgery in children with cystic fibrosis Bao Anh Do a , Larry C. Lands b , Marco A. Mascarella c, *, Amanda Fanous c , Christine Saint-Martin d , John J. Manoukian c , Lily H.P. Nguyen c, * a McGill University, Faculty of Medicine, Montreal, QC, Canada b Division of Peadiatric Respiratory Medicine, McGill University, Montreal, QC, Canada c Department of Otolaryngology Head & Neck Surgery, McGill University, Montreal, QC, Canada d Department of Diagnostic Radiology, McGill University, Montreal, Quebec, Canada 1. Introduction The Lund–Mackay (LM) score is a widely used and validated radiological scoring system for the evaluation of chronic rhino- sinusitis [1,2]. This scoring system allows for a straightforward way to grade the severity of sinonasal disease using computed tomography (CT), with higher scores indicative of more severe pathology [2]. The LM score was initially designed and validated in adults. Given the variability of sinus development in children, the modified Lund–Mackay (m-LM) scoring system was adapted for use in this population [3]. Despite this, its use in children with cystic fibrosis (CF) has not been fully explored [4–6]. Patients with CF frequently present with severe sinonasal disease often requiring multiple surgical interventions. Several studies have shown an association between the LM score and extent of sinus surgery in non-CF patients [5,6]. However, the literature on a relationship between radiological scoring of CT sinus scans and need for surgery in the CF population is scarce. In the literature, conflicting data exists regarding the role of CT sinus imaging in CF patients, as the majority of scans show radiologic abnormalities inconsistent with patient symptoms [5,7]. Nonetheless, the utility of the LM scoring system is to quantify the extent of inflammation of the nose and paranasal sinuses regardless of patient symptomatology [8]. As such, an objective measure could be used to follow patients throughout the course of their disease. International Journal of Pediatric Otorhinolaryngology 79 (2015) 1341–1345 A R T I C L E I N F O Article history: Received 15 March 2015 Received in revised form 2 June 2015 Accepted 4 June 2015 Available online 11 June 2015 Keywords: Cystic fibrosis Lund–Mackay score Modified Lund–Mackay score Functional endoscopic sinus surgery A B S T R A C T Objective: Patients with cystic fibrosis (CF) frequently present with severe sinonasal disease often requiring radiologic imaging and surgical intervention. Few studies have focused on the relationship between radiologic scoring systems and the need for sinus surgery in this population. The objective of this study is to evaluate the Lund–Mackay (LM) and modified Lund–Mackay (m-LM) scoring systems in predicting the need for sinus surgery or revision surgery in patients with CF. Methods: We performed a retrospective chart review of CF patients undergoing computed tomography (CT) sinus imaging at a tertiary care pediatric hospital from 1995 to 2008. Patient scans were scored using both the LM and m-LM systems and compared to the rate of sinus surgery or revision surgery. Receiver–operator characteristics curves (ROC) were used to analyze the radiological scoring systems. Results: A total of 41 children with CF were included in the study. The mean LM score for patients undergoing surgery was 17.3 (3.1) compared to 11.5 (6.2) for those treated medically (p < 0.01). For the m-LM, the mean score of patients undergoing surgery was 20.3 (3.5) and 13.5 (7.3) for those medically treated (p < 0.01). Using a ROC curve with a threshold score of 13 for the LM, the sensitivity was 89.3% (95% CI of 72–98) and specificity of 69.2% (95% CI of 39–91). At an optimal score of 19, the m-LM system produced a sensitivity of 67.7% (95% CI of 48–84) and specificity of 84.6% (95% CI of 55–98). Conclusion: The modified Lund–Mackay score provides a high specificity while the Lund–Mackay score a high sensitivity for CF patients who required sinus surgery. The combination of both radiologic scoring systems can potentially predict the need for surgery in this population. ß 2015 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: Department of Otolaryngology-Head and Neck Surgery Montreal Children’s Hospital 1001 boul. Decarie Montreal, Quebec, Canada, H4A 3J1. Tel: +1 514 412 4040; fax: +1 514 412 4342. E-mail addresses: marco.mascarella@mail.mcgill.ca (M.A. Mascarella), lily.hp.nguyen@gmail.com (Lily H.P. Nguyen). Contents lists available at ScienceDirect International Journal of Pediatric Otorhinolaryngology jo ur n al ho m ep ag e: ww w.els evier .c om /lo cat e/ijp o r l http://dx.doi.org/10.1016/j.ijporl.2015.06.007 0165-5876/ß 2015 Elsevier Ireland Ltd. All rights reserved.