Comparison of trans-nasal laryngoscopic office based biopsy of laryngopharyngeal lesions with traditional operative biopsy

Abstract

The objectives of this study are to compare the pathological results from office-based biopsy (OBB) and operative biopsy (ORB) of laryngopharyngeal lesions from 26 patients. Lesion location, specimen concordance, efficacy, cost savings, and patient management are discussed. OBB can provide a sample of laryngopharyngeal tissue that can be used to diagnose lesions in these sites. This study design is retrospective review and involved retrospective analysis and chart review of 26 cases of patients who had an OBB followed by and ORB of the same site; oropharyngeal or laryngopharyngeal lesion. CPT 31576 was to identify patients. Twenty six patients had both OBB and operative biopsy performed of a lesion within the oropharynx and laryngopharynx. All OBB attempts resulted in diagnostic tissue samples. Vocal fold biopsy (69 %) was most common. The most common OBB diagnosis was squamous cell carcinoma or moderate-to-severe dysplasia (54 %). OBB and ORB pathological results were the same in 81 % of patients. Of the benign samples obtained by OBB, 83 % of the ORB were deemed benign. Of the non-benign samples obtained via OBB, 80 % of the ORB were deemed non-benign in the operating room samples. Office-based biopsy is a simple procedure that can be performed in an outpatient setting, avoiding an operating room and the need for general anesthesia. Comparison of results from OBB to ORB together with patient characteristics resulted in very reliable results that can help to guide further patient management.

Safety of flexible endoscopic biopsy of the pharynx and larynx under topical anesthesia

“…In this study, a patient with a compromised airway was considered an absolute contraindication, which is in agreement with the reported literature [7]. In retrospect, the fourth case may not have had a compromised airway during biopsy, but he did have a compromised airway, which required a tracheotomy, when he was admitted to the emergency department.…”

“…Thus, the incidence was 0.5% for each complication. A few studies reported on the safety of FEB for laryngopharyngeal lesions, showing low complication rates [6, 7, 12–14]. Cohen et al reported three complications in 112 patients, including “a post-procedure aspiration in one patient (without serious consequences) and a self-limited epistaxis in two patients” [13].…”

“…No complications were reported and no association was observed with procedure tolerance or biopsy approach. Three other articles, with patient numbers varying from 12 to 76 patients, reported no complications during FEB [6, 7, 12]. …”

“…Its costs are relatively low compared with examination and biopsy under general anesthesia [12, 15]. Most importantly, FEB can often be performed during the initial outpatient visit or follow-up visit, which results in reduced diagnostic delay [7, 18]. An additional advantage of digital endoscopic techniques is the possibility of recording images, enabling more detailed reporting in the patient’s electronic file and comparison of images during follow-up.…”

“…Due to the relative novelty of this office-based procedure, few studies are available and complication rates have been assessed in small sample sizes [6, 7, 12–14, 19]. Therefore, the aim of this study was to investigate the complications of transnasal FEB under topical anesthesia in patients with benign and malignant laryngopharyngeal lesions.…”