Office-based flexible endoscopic guided biopsy: single-center feasibility analysis.

Abstract

Background: Direct laryngoscopy and biopsy have been the standard of care for biopsy of lesions arising from the upper aerodigestive tract (UADT). The requirement of general anesthesia is often a prerequisite. Procedures performed under the laryngeal block and local anesthesia are not viewed as appropriate from the point of view of patient comfort. Office-based flexible guided biopsy offers a less invasive alternative for obtaining biopsies from UADT.

Objective: To evaluate the yield, accuracy, feasibility, and safety of office-based flexible fiber-optic endoscope-directed biopsy (FEB) for laryngeal & pharyngeal lesions.

Methods: Setting- Tertiary care referral center.Retrospective cohort of FEB procedures undertaken in the period from June-December 2022.

Results: The study sample included 181 consecutive patients (median age 59 years) with lesions in supraglottis-25.4%, glottis-20.4%, nasopharynx-6%, oropharynx (base tongue/vallecula)-24.8%, and hypopharynx(pyriform fossa)-23.2%. The median time from outpatient visit to FEB was 1.9 days (1-4 days). Malignancy was confirmed in 166/181 patients, with 8 pre-malignant and 7 benign lesions. FEB confirmed the appropriate diagnosis in 159/181 (88.1%), and a repeat FEB in the 22 non-diagnostic situations yielded a diagnosis in another 8 (92.8% overall). The remaining 14 patients were appropriately diagnosed by a subsequent operating room endoscopy. The rate of conversion to direct laryngoscopy biopsy was approximately 7.73%. FEB demonstrated sensitivity (86.8%), specificity (100%), Positive Predictive Value (100%), Negative Predictive Value (23.3%), and overall Accuracy (87.29%). Univariate analysis indicated poor diagnostic yield for nasopharynx subsite (OR - 0.15; p = 0.003) and post-radiation/chemoradiation cases(OR - 7.04; p = 0.05). Multivariate analysis of the impact of patient characteristics, lesion subsite/morphology, and prior tracheostomy did not reveal a statistically significant association with histological yield. Mean biopsy time was 8 min with minor complications (pain/ minor bleeding) in 29/203 FEB procedures (14.28%), and major complications in 12(5.9%) (significant bleeding-2, airway compromise-9; death-1).

Conclusion: Office-based FFB is a viable alternative to direct laryngoscopic guided biopsy with acceptable sensitivity and specificity. Appropriate utilization of FFB will reduce the need for direct laryngoscopy.