School of Medicine, Ninewells Hospital, University of Dundee, Dundee, UK.
Department of Otolaryngology Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, UK.
Clin Otolaryngol. 2022 Mar;47(2):264-278. doi: 10.1111/coa.13897. Epub 2022 Jan 17.
In-office biopsies (IOB) using local anaesthetic for laryngopharyngeal tumours has become an increasingly popular approach since the advent of distal chip endoscopes. Although a wide range of studies advocate use in clinical practice, the widespread application of the procedure is hampered by concerns regarding diagnostic accuracy.
To assess the diagnostic accuracy of IOB performed via flexible endoscopy. In addition, to analyse modifiable factors that may affect diagnostic accuracy of IOB.
A systematic review following the PRISMA guidelines was conducted. PubMed, EMBASE, the Cochrane Library, Web of Science and CINAHL were used in the literature database search. Quality assessment of included studies was perfomed using the Newcastle-Ottawa Scale.
A total of 875 studies were identified, 16 of which were included into the systematic review; 1572 successful biopsies were performed using flexible endoscopy; 1283 cases were accurately diagnosed in the outpatient setting (81.6%) and 289 samples did not provide an accurate diagnosis (18.4%). The median sensitivity of IOB was 73%, and the specificity was 96.7%. Analysis of variable factors did not show any significant differences in method of approach, size of equipment (forceps) and additional lighting system or learning curve.
IOB are a viable tool for diagnostic workup of laryngopharyngeal tumours. Clinicians should be wary of reported limitations of IOB when benign or pre-malignant diagnoses are made. In cases suspicious of malignancy, confirmatory investigation should be conducted.
自远侧芯片内镜问世以来，使用局部麻醉进行喉咽肿瘤的门诊活检（IOB）已成为一种越来越受欢迎的方法。尽管广泛的研究提倡在临床实践中使用，但由于对诊断准确性的担忧，该程序的广泛应用受到了阻碍。
评估通过柔性内镜进行的 IOB 的诊断准确性。此外，分析可能影响 IOB 诊断准确性的可修改因素。
按照 PRISMA 指南进行系统评价。在文献数据库搜索中使用了 PubMed、EMBASE、Cochrane 图书馆、Web of Science 和 CINAHL。使用纽卡斯尔-渥太华量表对纳入研究进行质量评估。
共确定了 875 项研究，其中 16 项被纳入系统评价；共使用柔性内镜进行了 1572 次成功的活检；1283 例在门诊环境中得到准确诊断（81.6%），289 例样本未提供准确诊断（18.4%）。IOB 的中位敏感性为 73%，特异性为 96.7%。对可变因素的分析表明，方法、设备（活检钳）的大小、附加照明系统或学习曲线均无显著差异。
IOB 是诊断喉咽肿瘤的可行工具。当做出良性或癌前诊断时，临床医生应注意报告的 IOB 局限性。在疑似恶性肿瘤的情况下，应进行确认性检查。
