Mozzanica Francesco, Ottaviani Francesco, Ginocchio Daniela, Schindler Antonio
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy and Department of Otorhinolaryngology, Ospedale San Giuseppe IRCCS Multimedica, Milan, Italy.
IRCCS Santa Maria Nascente - Fondazione Don Gnocchi, Milan, Italy.
Iran J Otorhinolaryngol. 2020 Nov;32(113):373-378. doi: 10.22038/ijorl.2020.42544.2436.
Office-based laryngeal biopsy (OBLB) may provide a histological examination of laryngeal lesions in patients who cannot undergo a direct laryngoscopy. Nonetheless, only scarce information regarding its clinical applicability in these patients are available. The study's aim is to report the feasibility of OBLB in patients ineligible for direct laryngoscopy.
A total of 55 patients presenting with laryngeal lesions requiring biopsy but ineligible for direct laryngoscopy because at risk for general anesthesia were consecutively enrolled. OBLB was performed using a flexible endoscope with a 2 mm instrument channel under local anesthesia on an outpatient basis. The biopsied lesions were categorized according to their location, morphology, and histology (benign, premalignant, and malignant). In case of malignancy the patients started non-surgical treatment; otherwise, the patients were scheduled for a close follow-up.
OBLB was well tolerated and no complications occurred. Laryngeal lesions were more frequently located in the glottic region (28 out of 55 patients), while the most frequent morphology was ulcerative (35 out of 55 patients). The histological examination revealed 34 cases of malignancy, 9 cases of premalignancy, and 12 cases of benign lesions. In none of the patients without malignancy the laryngeal lesion showed significant changes during the follow-up period and a re-biopsy was not performed.
In patients ineligible for direct laryngoscopy under general anesthesia OBLB could be considered as a sound-alternative method to assess the histology of suspected laryngeal lesions.
对于无法接受直接喉镜检查的患者，门诊喉部活检（OBLB）可提供喉部病变的组织学检查。然而，关于其在这些患者中的临床适用性的信息却很少。本研究的目的是报告OBLB在不符合直接喉镜检查条件的患者中的可行性。
连续纳入55例因存在全身麻醉风险而需要活检但不符合直接喉镜检查条件的喉部病变患者。在门诊局部麻醉下，使用具有2毫米器械通道的柔性内窥镜进行OBLB。根据活检病变的位置、形态和组织学（良性、癌前病变和恶性）进行分类。如果是恶性肿瘤，患者开始非手术治疗；否则，患者安排密切随访。
OBLB耐受性良好，未发生并发症。喉部病变更常见于声门区（55例患者中有28例），而最常见的形态是溃疡性（55例患者中有35例）。组织学检查显示34例恶性肿瘤、9例癌前病变和12例良性病变。在无恶性肿瘤的患者中，喉部病变在随访期间均未出现明显变化，未进行再次活检。
对于不符合全身麻醉下直接喉镜检查条件的患者，OBLB可被视为评估疑似喉部病变组织学的一种可靠替代方法。
