Outcomes of office-based biopsies for laryngopharyngeal carcinoma – faster diagnoses and equivalent oncological outcomes as compared to biopsies under general anaesthesia
Reviewed by Christopher Burgess

Patients in the UK with head and neck cancers are the most likely to face long waits to treatment in comparison to other cancer sites, with only just over half commencing treatment within 62 days of being referred on a suspected cancer pathway. A systematic review in 2020 demonstrated that delays to initiating cancer treatment are associated with increased mortality for seven cancer types, including head and neck cancer. Office (clinic)-based biopsies utilising appropriate flexible endoscopic equipment have been proposed as a means of expediting cancer pathways, as well as freeing up operating theatre capacity and reducing healthcare costs. In this retrospective cohort study, 170 patients who underwent an office-based flexible laryngoscopic biopsy (FLB) were included for evaluation. The clinical outcomes of the 98 patients confirmed to have squamous cell carcinoma (SCC) via FLB were compared to 98 matched historic controls diagnosed with SCC via diagnostic endoscopy under general anaesthesia (DE-GA). Intolerance of standard diagnostic flexible laryngoscopy, inability to assess the full extent of a tumour in an outpatient setting and the use of more than one anticoagulant were contraindications to FLBs. FLB yielded a definitive diagnosis in 155/164 (95%) of patients with no complications observed. Nine false negative results were noted (benign on FLB but subsequently diagnosed as SCC after DE-GA). Median time from first visit to diagnosis was six days after FLB and 15 days after DE-GA. In the FLB group, 78% started treatment within six weeks of their initial visit, as compared to 42% in the DE-GA group (p < 0.001). Disease-specific survival was marginally greater in the FLB group (five-year DSS 83% for FLB, 79% for DE-GA) but this difference was not statistically significant (p = 0.4). Whilst the results from this study highlight the possibility of a false negative biopsy result from an FLB, this limitation can be mitigated by the maintenance of an appropriate index of clinical suspicion. Arguably, this potential drawback is more than outweighed by the significant improvement in time to treatment from referral associated with FLBs, given that an accurate diagnosis is yielded in the vast majority of patients with no complications noted in this series.

Diagnosis of laryngopharyngeal carcinoma through officed-based flexible laryngoscopy as a reliable alternative for biopsies under general anesthesia: Faster diagnostics with equal oncological outcome.
Westra JM, Scholman C, Krijnen HK, et al.
AM J OTOLARYNGOL
2024;45(5):104424.