The utility of office‐based biopsy for laryngopharyngeal lesions: Comparison with surgical evaluation

Abstract

Office biopsy may offer early direction and avoid operative intervention in some cases; however, for suspected dysplastic or malignant lesions, direct microlaryngoscopy should be the standard of care to ensure adequate full-thickness sampling and staging. For benign pathology, office biopsy is a safe and viable alternative to direct microlaryngoscopy and biopsy/excision.

Factors Associated With Infectious Laryngitis: A Retrospective Review of 15 Cases

“…A recent study comparing in-office versus operating room biopsies for pathologic diagnosis found that in-office biopsies had 60% sensitivity and 87% specificity when compared to the final pathologic diagnosis obtained in the operating room. 14 There was especially poor sensitivity when diagnosing dysplasia and carcinoma in situ on in-office biopsies. 14 In these cases, pathologic diagnosis can be difficult secondary to the small biopsy size and limited depth inherent to in-office biopsies.…”

“…14 There was especially poor sensitivity when diagnosing dysplasia and carcinoma in situ on in-office biopsies. 14 In these cases, pathologic diagnosis can be difficult secondary to the small biopsy size and limited depth inherent to in-office biopsies. These factors may not impact bacterial culture results from biopsied tissue.…”

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

“…Traditionally, the biopsy of laryngopharyngeal lesions is performed under general anesthesia. Technological advancements in the types of transnasal endoscopes, instrument miniaturization, and topical anesthetic techniques have led to a shift in laryngeal management from the operation room to an office-based setting [6–8]. Since the introduction of fiberoptic laryngoscopy in the 1970s, lighting and imaging techniques have improved substantially [9].…”

“…In the latter, information from a chip in the distal tip of the endoscope is send to a video processor, which creates a digital image and enables high-resolution imaging. Furthermore, endoscopes can be equipped with a built in working channel for passage of a flexible biopsy forceps or a laser fiber [6, 8, 10]. This enables clinicians to perform surgical procedures under topical anesthesia in an office-based setting, such as laser surgery or flexible endoscopic biopsy (FEB).…”

“…Office-based laryngeal FEB is reported to be safe [6, 12–14], feasible [6], cost-effective [12, 15], and easy to perform [13, 16]. The advantages are an awake patient who is sitting in an upright position and able to control laryngeal function during the procedure, which can result in adequate visualization of the designated lesion [10].…”