Time and Cost of Ultrasound‐Guided Fine‐Needle Aspiration Biopsy/Core‐Needle Biopsy for Primary Laryngohypopharyngeal Squamous Cell Carcinoma

Abstract

Objectives This study aimed to evaluate benefits in terms of time and cost of percutaneous ultrasound-guided fine-needle aspiration biopsy/core-needle biopsy (US-FNAB/CNB) for the diagnosis of primary laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC) in comparison with direct laryngoscopic biopsy (DLB) under general anesthesia. Study Design Retrospective case-control study. Setting Single operator of a single center. Subjects and Methods From 2018 to 2019, 28 patients who underwent percutaneous US-FNAB/CNB for the diagnosis of untreated LHSCC were enrolled. All US-FNAB/CNBs were performed in the outpatient department by a single head and neck surgeon. Their results were compared with those of 27 patients who underwent DLB under general anesthesia. Results No major complications occurred in the US-FNAB/CNB and DLB groups. Time to biopsy, time to pathologic diagnosis, and time to treatment initiation in the US-FNAB/CNB and DLB groups were 0 and 14 days ( P < .001), 7 and 20 days ( P < .001), and 24 and 35 days ( P = .001), respectively. Procedure-related costs were $368.5 and $981.0 in the US-FNAB/CNB and DLB groups ( P < .001). Conclusions US-FNAB/CNB offers true benefits in terms of time and cost over those given by conventional DLB for diagnosis of LHSCC in indicated patients.

A Case of Laryngeal Amyloidosis: Role of US and US-CNB for Preoperative Diagnosis

“…Conventionally, US examination has been considered to have a limited capacity for the evaluation of the larynx. 10,11) However, laryngeal masses in well-selected patients can be assessed with US through suitable anatomical windows, such as the suprahyoid regions, thyrohyoid membrane, and cricothyroid membrane. 12,13) Moreover, the utility of US can be enhanced unless the patient's thyroid cartilage is completely ossified.…”

“…Recently, several studies have reported the feasibility and results of office-based US-CNB for laryngeal and hypopharyngeal masses. 10,12) This technique is feasible in selected patients with a suitable tumor location and allows deep biopsy under real-time US monitoring, leading to accurate pathological diagnosis. Therefore, US-CNB could be a good alternative to avoid general anesthesia only for diagnostic procedure, particularly in patients with severe comorbidities and a high risk for general anesthesia.…”

“…In addition, careful consideration should be paid to major bleeding/hematoma at the larynx which can lead to serious medical situations even though it is extremely rare. 10) We always use Doppler US to identify vascular structures along the CNB path prior to the procedure to avoid major bleeding/hematoma and check the patient's larynx 30 min after the procedure for early detection of any laryngeal swelling.…”

Techniques in Otolaryngology: Ultrasound‐Guided Transcervical Fine‐Needle Aspiration of Laryngeal Masses

“…The application of ultrasound to image-guided biopsy of base of tongue, hypopharynx, thyroid nodules, and cervical lymph node metastases has been well documented, and its use in laryngeal cancer has been increasing in recent years. 1 - 4 Ultrasound-guided biopsy has high sensitivity and specificity, which are replicated through this technique to target laryngeal masses. 1 All patients in our study with squamous cell carcinoma were correctly diagnosed.…”

“…While TCUS-guided FNA does not replace the role of DLB for tumor mapping and surgical preparation, it proved to be a low-risk alternative that allowed for rapid tissue diagnoses. 2 , 3 Many of these patients had significant airway abnormalities, which would have necessitated tracheostomy in 4 cases to safely perform DLB. Tracheostomy results in hospitalization, with relative delay in diagnosis and treatment as compared with TCUS-guided FNA, with potentially worse outcomes.…”