Ansarin Mohssen, De Fiori Elvio, Preda Lorenzo, Maffini Fausto, Bruschini Roberto, Calabrese Luca, Jereczek-Fossa Barbara A, Chiesa Fausto, Bellomi Massimo
Division of Head and Neck Surgery, European Institute of Oncology, Milan, Italy.
Cancer. 2007 Jun 1;109(11):2268-72. doi: 10.1002/cncr.22679.
Patients with bulky laryngopharyngeal masses and a relative or absolute contraindication to general anesthesia present diagnostic difficulties. In the current study, the authors assessed the utility of transcutaneous ultrasound-guided Tru-Cut biopsy (USGTCB) under local anesthesia in such individuals.
The current report was a prospective, nonrandomized study. Patients meeting the inclusion criteria underwent USGTCB as outpatients.
Ten patients were recruited, 4 of whom had an untreated mass obstructing the laryngeal lumen and 6 of whom were previously treated for laryngeal cancer. All tolerated the procedure well. The only adverse event noted was spontaneously resolving near-syncope in 1 patient. In 9 patients the biopsy was diagnostic: invasive squamous cell carcinoma in 7 patients and chondronecrosis in 2 patients. In the remaining patient, radiologically suspected cricoid chondrosarcoma was confirmed based on the surgical specimen.
The results of this pilot study are encouraging. USGTCB of laryngopharyngeal masses was found to produce no local morbidity, was diagnostic in each of the 5 patients with suspected disease recurrence after radiotherapy, was feasible in the outpatient setting, and had high sensitivity and specificity. The procedure is particularly useful for patients contraindicated for general anesthesia or those with a risk of tracheotomy due to intubation difficulties.
患有巨大喉咽肿物且存在全身麻醉相对或绝对禁忌证的患者存在诊断难题。在本研究中，作者评估了局部麻醉下经皮超声引导下的Tru-Cut活检（USGTCB）在此类患者中的应用价值。
本报告为一项前瞻性、非随机研究。符合纳入标准的患者作为门诊患者接受USGTCB。
招募了10例患者，其中4例有未治疗的肿物阻塞喉腔，6例曾接受过喉癌治疗。所有患者对该操作耐受性良好。唯一记录到的不良事件是1例患者出现自行缓解的近似晕厥。9例患者的活检具有诊断意义：7例为浸润性鳞状细胞癌，2例为软骨坏死。在其余1例患者中，根据手术标本证实为放射学怀疑的环状软骨肉瘤。
这项初步研究的结果令人鼓舞。发现喉咽肿物的USGTCB不会产生局部并发症，在5例放疗后疑似疾病复发的患者中均具有诊断价值，在门诊环境中可行，且具有高敏感性和特异性。该操作对全身麻醉禁忌或因插管困难有气管切开风险的患者特别有用。
