Standardization of Nasal Cytology: An Expert-based Delphi Consensus

Standardization of the methodological and interpretative criteria for nasal citology through a structured expert consensus. Using a modified Delphi process, 100 members of the Italian Academy of Nasal Cytology (AICNA)—including allergists, otorhinolaryngologists, and pulmonologists—participated in three iterative rounds of evaluation of 30 statements addressing sampling, staining, microscopic assessment, and clinical interpretation. This consensus represents the first expert-based standardisation of nasal cytology methodology and interpretation, providing a robust framework for clinical and research applications. Nasal cytology is a simple, minimally invasive, and reproducible diagnostic technique that enables direct assessment of nasal epithelial and inflammatory cells. Despite its increasing use in the diagnosis and follow-up of allergic and non-allergic rhinitis, methodological variability has hindered its full standardisation. Consensus was defined as ≥ 70% agreement, using a likert scale ranging from 1 to 5, where scores > 3 indicated agreement. After three rounds, full or partial consensus was achieved for all 30 statements, confirming nasal cytology as a reliable, repeatable, and cost-effective diagnostic tool for assessing nasal inflammation. The consensus also established essential procedural standards, including sampling from the inferior turbinate, May–Grünwald–Giemsa staining, and semi-quantitative analysis of 50 microscopic fields. Moreover, the experts recognised nasal cytology as a valuable biomarker for the diagnosis, prognosis, and monitoring of rhinitis and chronic rhinosinusitis, and as a supporting instrument in precision medicine.