Diagnostic Accuracy Outcomes of Office-Based (Outpatient) Biopsies in patients with Laryngopharyngeal Lesions: A Systematic Review

Assessing the Accuracy, Safety, and Tolerance of Office-Based Endoscopic Biopsies for Laryngopharyngeal Lesions

OBJECTIVE

The increasing prevalence of office-based biopsies (OBBs) for diagnosing laryngopharyngeal lesions underscores the need for a comprehensive evaluation of their clinical utility. This study aims to investigate the accuracy, safety, and tolerance of these procedures in an office setting.

METHODS

We conducted a retrospective analysis of 490 OBBs performed with distal chip, working channel endoscopes. Histologic accuracy was assessed by comparing OBB results with operating room biopsies or, for benign lesions, by monitoring endoscopic findings over time.

RESULTS

The majority of OBBs were taken primarily from the glottic larynx (52.4%), supraglottic larynx (17.3%), and base of tongue (14.5%). Procedural intolerance led to noncompletion in 4.1% of cases due to gag reflex (17 cases) and laryngospasm (3 cases); no serious complications were reported. OBBs guided management in 88.4% of cases. Histologically, 33.3% of cases were benign, 27.6% pre-malignant, 37.6% malignant, and 1.5% yielded inadequate specimens. Thirteen lesions (8.3%) initially identified as benign and 37 pre-malignant lesions (28.5%) were found to be malignant upon further biopsy. For invasive malignancies/severe dysplasia, OBBs showed a sensitivity of 89.4%, specificity of 95.8%, positive predictive value of 97.4%, negative predictive value of 83.4%, and accuracy of 91.7%.

CONCLUSION

Office-based biopsies of laryngopharyngeal lesions are safe, generally well-tolerated, and offer reliable diagnostic results in appropriate clinical settings. Severe dysplasia or carcinoma in situ identified on OBB should prompt suspicion for invasive malignancy.

LEVEL OF EVIDENCE: 3

Randomized Controlled Trial of Awake Transnasal Laser-Assisted Surgery for Benign Laryngeal Lesions

OBJECTIVE

To compare functional and cost-effectiveness of awake transnasal laser assisted-surgery versus microlaryngeal surgery for benign laryngeal lesions.

METHODS

This was a prospective non-inferiority randomized controlled trial conducted from May 2021 to December 2022 at two tertiary referral hospitals in Hong Kong. Patients were block-randomized to receive either awake transnasal laser-assisted surgery or microlaryngeal surgery, with post-operative follow-up in a multidisciplinary voice clinic for 1-year. Primary outcome was Voice Handicap Index (VHI-30). Secondary outcomes included operation time, complications, length of stay, peri-operative discomfort, recurrence, and medical costs.

RESULTS

Sixty-one patients were randomized to either awake transnasal laser-assisted surgery (n = 30) and microlaryngeal surgery (n = 31). Both groups had comparable demographics and laryngeal pathologies. Both groups showed significant improvement of VHI-30 score over time and had comparable post-operative VHI-30. Awake transnasal laser-assisted surgery group had a significantly shorter length of stay (0.5 vs. 1 day) and less throat discomfort (2 vs. 4) compared to microlaryngeal surgery group. Intraoperative complications were more common in microlaryngeal surgery group (14.3% vs. 0%). Otherwise, both groups had similar operative time and recurrence rate. Cost-analysis showed a significantly lower hospital cost for awake transnasal laser-assisted surgery (USD 3090) compared to microlaryngeal surgery group (USD 5120).

CONCLUSION

Awake transnasal laser-assisted surgery was safe, functionally non-inferior, as measured by VHI-30, to microlaryngeal surgery in managing benign laryngeal lesions, while superior to microlaryngeal surgery in peri-operative discomfort and medical costs.

LEVEL OF EVIDENCE

2 Laryngoscope, 134:3732-3740, 2024.

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

BACKGROUND

There 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.

METHODS

Questionnaire-based prospective study of LA or general anesthetic (GA) biopsy for investigation of cancer from September 2021 to July 2022.

RESULTS

100% (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.

CONCLUSION

LA 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.

Surgical Treatment of Early Glottic Cancer

The incidence of all head and neck malignancies is rising worldwide, with carcinoma of the larynx constituting approximately 1% of all cancers. Early glottic cancer responds quite favorably to surgical intervention due to its early presentation, coupled with the low rate of regional and distant metastases. This article focuses on various approaches to the surgical treatment of early glottic cancer. Details include the clinical and radiological evaluation of laryngeal cancer, the goals of treatment, current surgical options for early disease, approach to surgical resection margins and management of nodal disease, and complications associated with each treatment modality.