Diagnosis and staging of laryngopharyngeal tumours with flexible endoscopy: A prospective study

Background Many suspected laryngopharyngeal neoplasms are examination under general anaesthesia (EUA). Office-based endoscopy is already routinely performed on all patients presenting with a suspected laryngopharyngeal neoplasm. Accurate clinical staging and tissue sampling using flexible endoscopy may eliminate the need for EUA. Aim To compare the use of flexible endoscopy to EUA as primary diagnostic tool of laryngopharyngeal lesions to EUA, using accuracy of tissue samples obtained and clinical staging as primary outcome measures. Duration, patient tolerance and cost implications were also assessed. Setting The study was performed in the outpatient department and surgical theatres of Tygerberg Hospital, Cape Town, South Africa. Methods A prospective study compared staging and tissue sampling accuracy with flexible endoscopy to EUA in 54 patients. Duration, tolerance and cost implications were also assessed. Results Flexible endoscopic biopsy had a 77.1% sensitivity, 100% specificity and 82.2% diagnostic accuracy. Liquid-based cytology had 97.3% sensitivity, 100% specificity and 97.9% diagnostic accuracy in differentiating high-grade lesions from low-grade lesions. Local staging agreement occurred in 88.6% (n = 31/35) of malignant cases. The mean duration was 15 ± 7 min; 86% of patients perceived the procedure as tolerable. Flexible endoscopy as a primary diagnostic tool would have avoided EUA in 68.6% (n = 24/35) of squamous cell carcinoma cases, with a R128 232 cost savings. Conclusion Office-based endoscopy is an accurate, well-tolerated, time- and cost-effective primary diagnostic tool of laryngopharyngeal lesions. It reduces the number of patients requiring EUA. Further evaluation is empirical when the histopathology does not confirm the clinical suspicion of malignancy.