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We evaluate the application of granular grading criteria to an endoscopic surgery predominant cohort with extended follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>78 ONB patients were identified (1994\u20132019) with original diagnoses dating to 1979. Original Hyams grade, Modified Hyams grade incorporating more detailed criteria and other histologic features (i.e. divergent differentiation, clear cell\/oncocytic change, and spindling) were assessed if feasible, evaluated for distribution by grade and correlated with outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Original Hyams grade (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200943) distribution was: I: 4 (9%), II: 27 (63%), III: 11 (26%), and IV: 1 (2%). Modified Hyams grade (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200959) distribution was: II: 29 (49%), III: 26 (44%), and IV: 4 (7%) with no grade I cases. Cases were more frequently upgraded with Modified Hyams grade. Mitotic rate (adjusted\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), pleomorphism (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and absence of rosettes (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002) were the only features that varied significantly between low grade (I-II) and high grade (III-IV) ONB. Neither Original nor Modified Hyams grade correlated significantly with any outcome endpoints by univariable Cox regression analysis (Median follow-up on surviving patients: 121.8 months). Splitting Modified Hyams grade into low and high trended towards a significant association with disease free survival on Kaplan Meier analysis (DFS, log rank\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.088). Severe nuclear pleomorphism correlated with adverse disease specific survival (Hazard ratio (HR): 8.092,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.024) and DFS (HR:3.81,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.033). On multivariable Cox regression, only procedure type (combined and transcranial approaches) remained significant prognosticators [HR:8.616,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004, and HR: 17.559,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.017, respectively] with Kadish-Morita Stage D being nearly significant [HR:14.35,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.054].\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Modified Hyams grade offers a slight improvement over Original Hyams grade but is still not particularly impactful as compared to disease extent\/stage and procedure type. Hyams grade I and IV are rare and likely unnecessary, justifying resolution of ONB grading to simply high and low grade. Furthermore, it appears that only a subset of parameters for Hyams grade is relevant in terms of classification and outcome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s12105-025-01804-z","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T14:44:36Z","timestamp":1753800276000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Refinement of Hyams Grading Criteria for Olfactory Neuroblastoma in an Endoscopic Sinus Surgery Predominant Cohort with Extended Follow-up: Worth the Effort?"],"prefix":"10.1007","volume":"19","author":[{"given":"Stacey M.","family":"Gargano","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Cracolici","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl H.","family":"Snyderman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric W.","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garret","family":"Choby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aron Z.","family":"Pollack","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A.","family":"Gardner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Bell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raja R.","family":"Seethala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,29]]},"reference":[{"key":"1804_CR1","first-page":"410","volume":"13","author":"L Berger","year":"1924","unstructured":"Berger L, Luc R, Richard D (1924) L\u2019Esth\u00e9sio-neuro-\u00e9pith\u00e9liome olfactif. 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