How accurate are in-office biopsies compared to direct microlaryngoscopy, and what is their diagnostic value?
Background: Advances in flexible laryngoscopy, imaging technology, instrument miniaturization, and procedure reimbursement changes have led to an increase in office-based laryngology management, obtaining tissue for pathology during an outpatient office visit using topical anesthesia. Office biopsy alone has been proposed as sufficient for several conditions, but the literature lacks data evaluating its accuracy compared with histologic diagnosis at operation.
Explore this issue:April 2015
Study design: Retrospective chart review of 76 patients who underwent office-based current procedural terminology code 31576 and were taken to the operating room for direct microlaryngoscopy with biopsy/excision from Jan. 1, 2010, through July 31, 2013.
Setting: Department of Otolaryngology, Icahn School of Medicine, Mount Sinai Hospital, New York City.
Synopsis: The median age of the 76 participants was 62, with a male-to-female ratio of 5:1. Of the 81 office biopsies, 76 were laryngeal and five were oropharyngeal (oropharynx subsites included two for tonsil, two for tongue base, and one for soft palate). There were no complications from any of the office or operative procedures performed. When groups 1 and 2 (lesions of uncertain significance and premalignant/malignancy) were considered together, the coefficient was 0.64, indicating substantial correlation. For malignant/premalignant lesions, the office biopsy analysis was as follows: sensitivity=60%, specificity=87%, positive predictive value=78%, and negative predictive value=74%. Sensitivity for malignancy/premalignancy was only 60%, indicating inadequacy as a diagnostic test. Only 15% of invasive squamous cell carcinoma (SCC) was identified at office biopsy. It should be noted, however, that when an office biopsy showed a diagnosis of SCC, it was correlated with the final histologic diagnosis in 100% of patients. Limitations included a selection bias determining the need for office biopsy and a possible skewing of office biopsy accuracy when different grades of dysplasia are considered.
Bottom line: For benign pathology, office biopsy is a safe and viable alternative to direct microlaryngoscopy and biopsy/excision, but for suspected dysplastic or malignant lesions, direct microlaryngoscopy should be the standard of care.
Citation: Richards AL, Sugumaran M, Aviv JE, Woo P, Altman KW. The utility of office-based biopsy for laryngopharyngeal lesions: comparison with surgical evaluation. Laryngoscope. 2015;125:909-912.
—Reviewed by Amy Hamaker