EurAsia Group introduces a clinically practical classification for CRSwNP

Chronic rhinosinusitis with nasal polyps (CRSwNP) is one of the most challenging inflammatory diseases encountered in rhinology. Although nasal polyps are often grouped under a single diagnosis, experienced clinicians know that not all polyps behave the same. Some recur rapidly, some remain localized, and others respond poorly to both surgery and medical therapy. To address this clinical gap, the EurAsia Group has contributed to a landmark study proposing a new, clinically relevant classification and staging system for CRSwNP, recently published in the peer-reviewed journal Diagnostics (Impact Factor ~3.0; CiteScore ~4.9).

Why was a new classification needed?

Most existing systems focus heavily on histology or blood biomarkers, which are not always available at the point of care. Others distinguish eosinophilic from non-eosinophilic disease but stop short of offering a practical severity staging system that can guide treatment decisions. This study was designed with everyday clinical practice in mind. By integrating nasal endoscopy and CT imaging, the authors aimed to create a framework that allows clinicians to:

• Recognize distinct disease patterns during routine assessment

• Estimate disease severity without relying solely on laboratory markers

• Plan surgery and medical therapy more precisely

One of the largest single-cohort studies to date

The study analyzed 2,060 patients with CRSwNP evaluated over more than six years. Each patient underwent standardized clinical assessment, nasal endoscopy, CT imaging, and histopathologic correlation when indicated. Based on consistent endoscopic and radiologic features, CRSwNP was classified into three distinct phenotypes:

• Eosinophilic CRSwNP (ECRSwNP): Typically aggressive, diffuse, and associated with asthma, anosmia, osteitis, and a high risk of recurrence.

• Non-eosinophilic CRSwNP (NECRSwNP): More localized disease, often maxillary-predominant, usually driven by neutrophilic inflammation.

• Central Compartment Atopic Disease (CCAD): A distinct, allergy-driven entity centered on the middle turbinate, superior turbinate, and nasal septum, characterized by the classic “black halo sign” on CT.

Each phenotype was further divided into severity stages, using reproducible endoscopic landmarks and CT-based markers such as sinus opacification patterns, osteitis burden, and neo-osteogenesis.

From imaging to decision-making

One of the most important strengths of this work is its high reproducibility. Independent reviewers demonstrated near-perfect agreement when applying the classification and staging system, confirming that it can be reliably used across clinicians.

More importantly, the system directly supports clinical decisions:

• Identifying patients who may benefit from extended surgery

• Recognizing advanced eosinophilic disease that may require biologic therapy

• Avoiding overtreatment in localized or non-eosinophilic disease

Advancing personalized care in rhinology

This study reflects the EurAsia Group’s broader mission: translating large-scale clinical experience into practical tools that improve patient care across different healthcare settings. By bridging endoscopy, imaging, and pathology into a single framework, this classification moves CRSwNP management closer to precision medicine, where treatment is tailored to disease behavior rather than a one-size-fits-all approach.

Read the full study

The full open-access article is available in Diagnostics and can be accessed here.