The clinical diagnosis of Acute Invasive Fungal Rhinosinusitis (AIFRS) is technically difficult because it presents with non-exclusive and nonspecific clinical symptoms. Laboratory confirmation (usually via histopathologic techniques such as formalin-fixed paraffin-embedded (FFPE)) is necessary but it is time-consuming, despite the urgent need for timely diagnosis of AIFRS for effective management. This study aimed to investigate the sensitivity and specificity of the GMS frozen-section biopsy in the diagnosis of AIFRS and compare the same with that of different tissue staining methods to provide valid decision-grounds that may guide clinicians in prompt diagnosis of acute fungal invasive rhinosinusitis. A cross-sectional study was conducted in the Medical Mycology Laboratory, Faculty of Medicine, Iran University of Medical Sciences between 2018 and 2020 on 200 patients with suspected AIFRS referred to Baqiyatallah and Imam Khomeini Hospital, Tehran. All patients were subjected to diagnostic nasal endoscopy and computed tomography (CT) scan of paranasal sinuses. Magnetic resonance imaging (MRI) was done in cases of suspected intracranial extension. After screening by routine mycological examination, the diagnosis was confirmed using complementary molecular methods. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the frozen-section biopsy were also compared with FFPE. Of the 200 suspect patients, 47 cases (23.5%) met the criteria for AIFRS. Species of the genus Aspergillus were the predominant 27 (57.4%) followed by Mucorales species 10 (21.3%), and Fusarium spp 3 (6.4%). Also, 3 cases (6.4%) of co-infection due to Aspergillus/Rhizopus were reported. The accuracy, sensitivity, specificity, PPV, and NPV of frozen section assessments were 99.5%, 97.9%, 100%, 100% and 99.3%, respectively. For GMS frozen-section alone, sensitivity, specificity, NPV, and PPV was 100%. Overall, the calculated accuracy of FFPE was 98.5%, sensitivity was 94%, specificity was 100%, PPV was 100%, and NPV was 98.1%. Examination of the frozen-section biopsy is a highly predictive tool for a rapid and effective diagnosis of patients with suspected AIFRS. We observed that GMS frozen-section is a fast and reliable exam to confirm the diagnosis of fungal invasion, with good accuracy, sensitivity, and specificity compared to the gold-standard FFPE biopsy.

急性侵袭性真菌性鼻窦炎 (AIFRS) 的临床诊断在技术上是困难的，因为它具有非排他性和非特异性的临床症状。实验室确认（通常通过福尔马林固定石蜡包埋 (FFPE) 等组织病理学技术）是必要的，但它很耗时，尽管迫切需要及时诊断 AIFRS 以进行有效管理。本研究旨在探讨 GMS 冰冻切片活检在 AIFRS 诊断中的敏感性和特异性，并与不同组织染色方法的敏感性和特异性进行比较，以提供有效的决策依据，以指导临床医生及时诊断急性真菌性侵袭性鼻窦炎。 . 一项横断面研究在医学院医学真菌学实验室进行，伊朗医科大学在 2018 年至 2020 年期间将 200 名疑似 AIFRS 的患者转诊至德黑兰 Baqiyatallah 和伊玛目霍梅尼医院。所有患者均接受诊断性鼻内窥镜检查和鼻窦计算机断层扫描 (CT) 扫描。在怀疑颅内扩展的情况下进行磁共振成像 (MRI)。通过常规真菌学检查筛选后，使用补充分子方法确认诊断。冷冻切片活检的敏感性、特异性、阳性预测值 (PPV) 和阴性预测值 (NPV) 也与 FFPE 进行了比较。在 200 名疑似患者中，47 例 (23.5%) 符合 AIFRS 的标准。属的物种 所有患者均接受诊断性鼻内窥镜检查和鼻窦计算机断层扫描 (CT) 扫描。在怀疑颅内扩展的情况下进行磁共振成像 (MRI)。通过常规真菌学检查筛选后，使用补充分子方法确认诊断。冷冻切片活检的敏感性、特异性、阳性预测值 (PPV) 和阴性预测值 (NPV) 也与 FFPE 进行了比较。在 200 名疑似患者中，47 例 (23.5%) 符合 AIFRS 的标准。属的物种 所有患者均接受诊断性鼻内窥镜检查和鼻窦计算机断层扫描 (CT) 扫描。在怀疑颅内扩展的情况下进行磁共振成像 (MRI)。通过常规真菌学检查筛选后，使用补充分子方法确认诊断。冷冻切片活检的敏感性、特异性、阳性预测值 (PPV) 和阴性预测值 (NPV) 也与 FFPE 进行了比较。在 200 名疑似患者中，47 例 (23.5%) 符合 AIFRS 的标准。属的物种 使用补充分子方法证实了诊断。冷冻切片活检的敏感性、特异性、阳性预测值 (PPV) 和阴性预测值 (NPV) 也与 FFPE 进行了比较。在 200 名疑似患者中，47 例 (23.5%) 符合 AIFRS 的标准。属的物种 使用补充分子方法证实了诊断。冷冻切片活检的敏感性、特异性、阳性预测值 (PPV) 和阴性预测值 (NPV) 也与 FFPE 进行了比较。在 200 名疑似患者中，47 例 (23.5%) 符合 AIFRS 的标准。属的物种曲霉菌是主要的 27 种 (57.4%)，其次是毛霉属 10 种 (21.3%) 和镰刀菌 3 (6.4%)。此外，3 例 (6.4%) 由曲霉属/根霉属引起的合并感染被举报。冰冻切片评估的准确性、敏感性、特异性、PPV 和 NPV 分别为 99.5%、97.9%、100%、100% 和 99.3%。对于单独的 GMS 冰冻切片，敏感性、特异性、NPV 和 PPV 为 100%。总体而言，FFPE 的计算准确率为 98.5%，敏感性为 94%，特异性为 100%，PPV 为 100%，NPV 为 98.1%。冰冻切片活检是快速有效诊断疑似 AIFRS 患者的高度预测工具。我们观察到，与金标准 FFPE 活检相比，GMS 冰冻切片是一种快速可靠的检查，可确认真菌侵袭的诊断，具有良好的准确性、敏感性和特异性。