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The Laryngoscope

2014 The American Laryngological,

Rhinological and Otological Society, Inc.

The Utility of Office-Based Biopsy for Laryngopharyngeal Lesions:

Comparison with Surgical Evaluation

Amanda L. Richards, MBBS, FRACS; Manikandan Sugumaran, MD; Jonathan E. Aviv, MD;

Peak Woo, MD; Kenneth W. Altman, MD, PhD

Objectives/Hypothesis:

Advances in flexible endoscopy with working-channel biopsy forceps have led to excellent visu-

alization of laryngopharyngeal lesions with capability for in-office awake biopsy. Potential benefits include prompt diagnosis

without risk of general anesthesia, preoperative counseling, and avoiding an anesthetic should the lesion return benign. We

evaluate the accuracy of these biopsies in order to determine their role and diagnostic value.

Study Design:

Retrospective chart review.

Methods:

Medical records were reviewed from January 1, 2010, through July 31, 2013, of patients who underwent

office-based current procedural terminology code 31576 and were taken to the operating room for direct microlaryngoscopy

with biopsy/excision. Clinical diagnoses and pathology reports were reviewed. For statistical analysis, we considered three

groups: 1) malignant and premalignant, 2) lesions of uncertain significance, and 3) benign lesions.

Results:

In the study period, 76 patients with an office biopsy had a clinical picture to warrant direct microlaryngo-

scopy and biopsy/excision. Kendall’s coefficient for each group indicated moderate correlation only. When groups 1 and 2

were considered together, there was a substantial and statistically significant correlation. For malignant and premalignant

lesions, the office biopsy analysis was as follows: sensitivity

60%, specificity

87%, positive predictive value

78%, and

negative predictive value

74%.

Conclusion:

Office biopsy may offer early direction and avoid operative intervention in some cases; however, for sus-

pected 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 microlaryngo-

scopy and biopsy/excision.

Key Words:

Office biopsy, lesion, leukoplakia, dysplasia, microlaryngoscopy, medical decision making.

Level of Evidence:

Laryngoscope

, 125:909–912, 2015

INTRODUCTION

Advances in flexible laryngoscopy, imaging technol-

ogy, instrument miniaturization, and changes to proce-

dure reimbursement have led to an increase in office-

based management in laryngology. Since the introduc-

tion of the fiber optic laryngoscope in 1976, there have

been steady advances in the quality of lighting and

imaging for office laryngeal examinations from fiber

optic to distal chip endoscopes.

Also, adaptations in the

design of the flexible scopes have allowed for the use of

a side channel port or disposable sheath for passage of a

cupped laryngeal biopsy forceps.

The combination of

these forceps with optimal imaging has provided an

option to obtain tissue for pathology during an outpa-

tient office visit with topical anesthesia. Traditionally,

these patients would require a visit to the operating

room (OR) with general anesthesia for a direct microlar-

yngoscopy and biopsy or excision of the lesion. However,

regardless of technique, all biopsies need to provide a

representative sample of the lesion to demonstrate cell

morphology. In addition, sample depth is also important,

particularly in cases of dysplasia for which deeper levels

may determine a different diagnosis and prognosis.

There are a proposed number of conditions for

which office biopsy alone has been proposed as suffi-

cient: 1) confirmed diagnosis of carcinoma when clini-

cally suspected; 2) complete excision of a lesion at the

time of office biopsy; 3) benign pathology and resolution

of the lesion with treatment; 4) evidence for keratosis,

papilloma, or mild dysplasia with stable clinical exami-

nation; and 5) the risks of surgical evaluation with gen-

eral anesthesia outweigh the potential diagnostic or

therapeutic benefits of the procedure. Potential benefits

include the following: 1) avoiding the risk of general

anesthesia, 2) reduced duration from clinical suspicion

to histologic confirmation, 3) negating patient anatomic

limitations, and 4) avoiding the costs of general anesthe-

sia and the OR.

From the Department of Otolaryngology–Head and Neck Surgery,

Icahn School of Medicine, Mount Sinai Hospital, New York, New York,

U.S.A.

Editor’s Note: This Manuscript was accepted for publication

October 7, 2014.

Dr. Aviv is shareholder in Vision Sciences. The authors have no

other funding, financial relationships, or conflicts of interest to disclose.

Send correspondence to Kenneth W. Altman, MD, PhD, FACS,

Professor and Vice Chair for Clinical Affairs, Director, The Institute for

Voice and Swallowing at BCM, Bobby R. Alford Department of Otolaryn-

gology - HNS, Baylor College of Medicine, 6501 Fannin Street, Room NA

102, Houston, TX 77030. E-mail:

Kenneth.Altman@bcm.edu

DOI: 10.1002/lary.25005

Laryngoscope 125: April 2015

Richards et al.: Office-Based Biopsy for Laryngopharyngeal Lesions

Reprinted by permission of Laryngoscope. 2015; 125(4):909-912.