Assessing pediatric adenoid hypertrophy: a study on the reliability of radiographic vs. endoscopic techniques

Lateral neck radiography, especially the Fujioka and Cohen methods, has been widely used to assess adenoid size. This study aimed to compare the diagnostic accuracy of these two radiographic screening methods with that of drug-induced sleep endoscopy (DISE), valuable tool for evaluating adenoid hypertrophy. In this cross-sectional study, patients with adenoid hypertrophy who were scheduled for adenoidectomy were enrolled. The size of the adenoid was graded via lateral neck radiographs via the Fujioka and Cohen methods. All patients also underwent DISE. The correlation between the radiographic methods and DISE was examined. On the basis of DISE, the grades of adenoid obstruction in 48 subjects were as follows: Grade I (12.5%), Grade II (22.9%), Grade III (47.9%), and Grade IV (16.7%). A significant correlation was observed between DISE and both the Fujioka ( r = 0.670, p = 0.001) and Cohen ( r = 0.458, p = 0.001) methods. ROC curve analysis revealed that the optimal cutoff values for the Fujioka and Cohen methods were 1.5 and 3.5, respectively. The Fujioka method had a sensitivity of 100% and a specificity of 52.9%, whereas the Cohen method had a sensitivity of 83.3% and specificity of 75.0%. Both the Fujioka and Cohen methods of lateral neck radiography are valid and reliable methods for assessing adenoid size. The Fujioka method shows higher sensitivity, whereas the Cohen method demonstrates better specificity. These radiographic methods can serve as reliable initial screening tools to identify patients who may require further definitive evaluation with DISE, particularly in clinical settings where endoscopy is not immediately available or feasible.