Application of Flexible Endoscopy-Based Biopsy in the Diagnosis of Tumour Pathologies in Otorhinolaryngology

Saga, Carlos; Olalde, Manuel; Larruskain, Ekhiñe; Álvarez, Leire Parapar; Altuna, Xabier

doi:10.1016/j.otoeng.2017.12.008

Cited by 5 publications

(17 citation statements)

References 14 publications

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“…Most authors opted for 1.8‐mm or 2‐mm forceps (serrated or non‐serrated). Studies that chose biopsy forceps greater than 2 mm 6,8,20,26 were found to have an average diagnostic accuracy of 73.9% while studies that chose biopsy forceps <2 mm had a diagnostic accuracy of 74.6% 12,15,22,24,25,27 . The significance of this result remains difficult to determine as studies were conducted with different methodologies and varying cohorts.…”

Section: Discussionmentioning

confidence: 99%

“…Specificity is the measure of a test's ability to classify an individual as disease‐free 21 . Specificity was reported in 10 studies and ranged between 75.6% 20 and 100% 7,15,18,22,23 with a median value of 96.7%. It may be relevant that the only study that incorporated trans‐oral flexible endoscopic biopsies not only showed 100% sensitivity 20 but also reported the lowest specificity rate (75.6%).…”

Section: Discussionmentioning

confidence: 99%

“…Specificity is the measure of a test's ability to classify an individual as disease-free. 21 Specificity was reported in 10 studies and ranged between 75.6% 20 and 100% 7,15,18,22,23 with a median value of 96.7%.…”

Section: Specificitymentioning

confidence: 99%

“…Studies that chose biopsy forceps greater than 2 mm 6,8,20,26 were found to have an average diagnostic accuracy of 73.9% while studies that chose biopsy forceps <2 mm had a diagnostic accuracy of 74.6%. 12,15,22,24,25,27 The significance of this result remains difficult to determine as studies were conducted with different methodologies and varying cohorts. In addition, factors such as patient compliance would have an equal or greater effect on size of sample acquired, possibly affecting diagnostic accuracy.…”

Section: Forceps Sizementioning

confidence: 99%

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Diagnostic accuracy outcomes of office‐based (outpatient) biopsies in patients with laryngopharyngeal lesions: A systematic review

Owusu-Ayim

Ranjan

Lim

et al. 2022

Clinical Otolaryngology

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Background:In-office biopsies (IOB) using local anaesthetic for laryngopharyngeal tumours has become an increasingly popular approach since the advent of distal chip endoscopes. Although a wide range of studies advocate use in clinical practice, the widespread application of the procedure is hampered by concerns regarding diagnostic accuracy.Objective: To assess the diagnostic accuracy of IOB performed via flexible endoscopy.In addition, to analyse modifiable factors that may affect diagnostic accuracy of IOB.Design: A systematic review following the PRISMA guidelines was conducted.PubMed, EMBASE, the Cochrane Library, Web of Science and CINAHL were used in the literature database search. Quality assessment of included studies was perfomed using the Newcastle-Ottawa Scale.Results: A total of 875 studies were identified, 16 of which were included into the systematic review; 1572 successful biopsies were performed using flexible endoscopy; 1283 cases were accurately diagnosed in the outpatient setting (81.6%) and 289 samples did not provide an accurate diagnosis (18.4%). The median sensitivity of IOB was 73%, and the specificity was 96.7%. Analysis of variable factors did not show any significant differences in method of approach, size of equipment (forceps) and additional lighting system or learning curve. Conclusion:IOB are a viable tool for diagnostic workup of laryngopharyngeal tumours. Clinicians should be wary of reported limitations of IOB when benign or pre-malignant diagnoses are made. In cases suspicious of malignancy, confirmatory investigation should be conducted.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Specificitymentioning

confidence: 99%

Section: Forceps Sizementioning

confidence: 99%

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Diagnostic accuracy outcomes of office‐based (outpatient) biopsies in patients with laryngopharyngeal lesions: A systematic review

Owusu-Ayim

Ranjan

Lim

et al. 2022

Clinical Otolaryngology

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“…Accuracy rates of FEB in diagnosing benign and malignant laryngopharyngeal pathology have varied widely over existing studies; that is 64% to 98%. [2][3][4]9,10,12,13,15 Factors that influence the diagnostic value have yet to be investigated. For example, the number of obtained biopsies and their representativeness, difficulties encountered during the procedure, biopsy site, or the experience and skill level of attending physicians could impact the diagnostic value of FEB.…”

Section: Introductionmentioning

confidence: 99%

Flexible Endoscopic Biopsy: Identifying Factors to Increase Accuracy in Diagnosing Benign and Malignant Laryngopharyngeal Pathology

et al. 2022

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Objectives. To assess the influence that several factors, such as the amount of obtained biopsies, difficult procedures, biopsy site and the experience of the attending physician, have on accuracy of flexible endoscopic biopsy (FEB). Materials and methods. 203 FEB procedures for benign or malignant laryngopharyngeal lesions were prospectively included. During the procedure, three representative biopsies (macroscopically containing vital tumor tissue and not only necrosis or healthy tissue) were obtained. The accuracy of each biopsy was separately analyzed. Difficulties during the procedures leading to failure of acquiring three representative biopsies were recorded and classified into tumor, patient and procedural factors. Histological results of FEB were defined correct when consistent with clinical context, additional biopsies or Positron emission tomography-computed tomography (PET-CT) revealed equivalent pathology, or the lesion was stable or resolved in >6 months follow-up. Results. The first representative biopsy yielded a correct diagnosis in 65% of the cases. After the second representative biopsy, 78% was correctly diagnosed. The contribution of the third and fourth representative biopsies to accuracy was 3%. The overall accuracy of FEB was 85%. Difficult procedures were more likely to result in misdiagnosis, whereas biopsy site or experience of the attending physician did not influence results. Conclusions. FEB was accurate in diagnosing laryngopharyngeal lesions when at least two representative biopsies were obtained. Accuracy of FEB could be further improved by limiting possible constraints during the procedures, for example by selecting, informing, and anesthetizing patients carefully.

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Prospective cohort study assessing patient satisfaction and diagnostic accuracy in channeled endoscope local anesthetic biopsy in the investigation of head and neck cancer

Lim,

Rogers,

Montgomery

2023

Head & Neck

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BackgroundThere are delays in the head and neck Urgent Suspicion of Cancer (USOC) pathway. Local anesthetic (LA) biopsy with channeled endoscopes in outpatients can reduce time to diagnosis.MethodsQuestionnaire‐based prospective study of LA or general anesthetic (GA) biopsy for investigation of cancer from September 2021 to July 2022.Results100% (n = 48) were very satisfied or satisfied with their overall experience. 71% (n = 20) of LA patients reported they would prefer to have a biopsy under LA. LA biopsy was 68% sensitive and 100% specific for cancer diagnosis. 28.6% (8) and 10% (2) of LA and GA patients had palliative MDT outcomes. Median time to diagnosis was 44.5 and 49.0 days for LA and GA biopsy, respectively.ConclusionLA biopsy had a high satisfaction rate and is sensitive for diagnosing cancer. LA biopsy can expedite treatment pathways. LA biopsy should be considered as an option for first line investigation.

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Application of Flexible Endoscopy-Based Biopsy in the Diagnosis of Tumour Pathologies in Otorhinolaryngology

Cited by 5 publications

References 14 publications

Diagnostic accuracy outcomes of office‐based (outpatient) biopsies in patients with laryngopharyngeal lesions: A systematic review

Diagnostic accuracy outcomes of office‐based (outpatient) biopsies in patients with laryngopharyngeal lesions: A systematic review

Flexible Endoscopic Biopsy: Identifying Factors to Increase Accuracy in Diagnosing Benign and Malignant Laryngopharyngeal Pathology

Prospective cohort study assessing patient satisfaction and diagnostic accuracy in channeled endoscope local anesthetic biopsy in the investigation of head and neck cancer

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