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

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. To evaluate the yield, accuracy, feasibility, and safety of office-based flexible fiber-optic endoscope-directed biopsy (FEB) for laryngeal & pharyngeal lesions. Setting- Tertiary care referral center.Retrospective cohort of FEB procedures undertaken in the period from June-December 2022. 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). 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.