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Traditionally, patients warranting direct microlar-
yngoscopy after office biopsy are those with limited tis-
sue obtained during attempted office biopsy, a concern
regarding false-negative office biopsy results, a require-
ment for disease volume reduction to avoid respiratory
or swallowing impairment, and a need for excision of the
lesion to improve the voice. Other advantages of direct
microlaryngoscopy include a more detailed examination
of the extent of a tumor, more accurate biopsy capabil-
ities, and the option for definitive treatment by excision
for many lesions.
Despite the popularity of office biopsy, there is a
paucity of data in the literature evaluating the accuracy
compared to histologic diagnosis at operation. The goals
of this study are to determine the accuracy of office biop-
sies when compared to direct microlaryngoscopy and to
evaluate its role and diagnostic value.
MATERIALS AND METHODS
A retrospective medical chart review was performed from
January 1, 2010, to July 31, 2013, after receiving approval from
the Institutional Review Board Human Subjects Committee.
This review identified 261 patients in the clinical practices of
the authors who underwent office biopsy (current procedural
terminology code 31576) for laryngeal and pharyngeal lesions.
Patients’ records were then reviewed to determine those who
underwent direct microlaryngoscopy with biopsy.
Patients who had resolution of the lesion following biopsy,
surveillance of a previously histologically proven benign diagno-
sis, and a definitive diagnosis of cancer who proceeded to non-
surgical definitive treatment were excluded from the study. We
also excluded current anticoagulation, anterior commissure
lesions, submucosal lesions, and anatomically obstructive
pathology. Patients with brush biopsy alone were also excluded.
The pathology reports were reviewed for consistency between
office and surgical specimens and compared to clinical diagno-
ses. The flow of the patients is summarized in Figure 1.
Office biopsies were performed using distal chip video endo-
scopes (ENT-5000, Vision Sciences, Inc. or VNL-1570STK,
KayPENTAX Montvale, NJ) in conjunction with a 2-mm channel
endosheath and 1.8-mm nonserrated cup biopsy forceps. The
nasal cavity was anesthetized with aerosolized 4% lidocaine with
epinephrine 1:100,000 or 4% lidocaine with phenylephrine hydro-
chloride. The channel-sheathed video endoscope was then passed
transnasally into the laryngopharynx. Topical laryngopharyngeal
anesthesia was achieved by delivering 0.5 cc of plain 4% lido-
caine to the laryngeal surface of the epiglottis. Once supraglottic
anesthesia was achieved, 1 to 2 cc of plain 4% lidocaine was then
delivered topically to the glottis. The 1.8-mm biopsy forcep was
then passed under videoendoscopic guidance and biopsies were
performed.
Direct microlaryngoscopy with biopsy was performed under
general anesthesia, and lesions were visualized with a zero-
degree telescope and binocular microscope. Lesions were excised
or sampled for pathologic evaluation using phonosurgical instru-
ments. The procedures included a submucosal dissection in order
to obtain epithelial basement membrane in the specimen.
Office biopsy results were divided into clinically relevant
groups that would normally used to direct patient care algo-
rithms. For example, mild to moderate dysplasia was separated
from severe dysplasia and carcinoma in situ (CIS)/squamous
cell carcinoma (SCC). For statistical analysis, we considered
three groups: 1) malignant and premalignant (SCC, CIS, and
severe dysplasia); 2) lesions of uncertain significance (mild–
moderate dysplasia and hyperkeratosis); and 3) benign lesions.
Patients who were noted to have a dual diagnosis on histology
(e.g., inflammation with mild dysplasia) were analyzed within
the group that would direct their final treatment.
To test interrater reliability, we utilized Kendall’s coeffi-
cient of concordance for the numerically coded ordinal responses
Fig. 1. Flow of office biopsy patients. (Operating room biopsy diagnoses are listed in the last row). [Color figure can be viewed in the online
issue, which is available at
wileyonlinelibrary.com.]
Laryngoscope 125: April 2015
Richards et al.: Office-Based Biopsy for Laryngopharyngeal Lesions
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