Clark Alexander, Nam You Sung, MacKay Colin, Bullock Martin, Brown Timothy
Division Otolaryngology - Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada.
Laryngoscope. 2025 Sep;135(9):3287-3295. doi: 10.1002/lary.32197. Epub 2025 May 3.
The increasing prevalence of office-based biopsies (OBBs) for diagnosing laryngopharyngeal lesions underscores the need for a comprehensive evaluation of their clinical utility. This study aims to investigate the accuracy, safety, and tolerance of these procedures in an office setting.
We conducted a retrospective analysis of 490 OBBs performed with distal chip, working channel endoscopes. Histologic accuracy was assessed by comparing OBB results with operating room biopsies or, for benign lesions, by monitoring endoscopic findings over time.
The majority of OBBs were taken primarily from the glottic larynx (52.4%), supraglottic larynx (17.3%), and base of tongue (14.5%). Procedural intolerance led to noncompletion in 4.1% of cases due to gag reflex (17 cases) and laryngospasm (3 cases); no serious complications were reported. OBBs guided management in 88.4% of cases. Histologically, 33.3% of cases were benign, 27.6% pre-malignant, 37.6% malignant, and 1.5% yielded inadequate specimens. Thirteen lesions (8.3%) initially identified as benign and 37 pre-malignant lesions (28.5%) were found to be malignant upon further biopsy. For invasive malignancies/severe dysplasia, OBBs showed a sensitivity of 89.4%, specificity of 95.8%, positive predictive value of 97.4%, negative predictive value of 83.4%, and accuracy of 91.7%.
Office-based biopsies of laryngopharyngeal lesions are safe, generally well-tolerated, and offer reliable diagnostic results in appropriate clinical settings. Severe dysplasia or carcinoma in situ identified on OBB should prompt suspicion for invasive malignancy.
用于诊断喉咽病变的门诊活检（OBB）的患病率不断上升，这凸显了对其临床效用进行全面评估的必要性。本研究旨在调查这些操作在门诊环境中的准确性、安全性和耐受性。
我们对使用远端芯片工作通道内窥镜进行的490例OBB进行了回顾性分析。通过将OBB结果与手术室活检结果进行比较来评估组织学准确性，对于良性病变，则通过长期监测内镜检查结果来评估。
大多数OBB主要取自声门喉（52.4%）、声门上喉（17.3%）和舌根（14.5%）。操作不耐受导致4.1%的病例因 gag 反射（17例）和喉痉挛（3例）而未完成；未报告严重并发症。88.4%的病例中OBB指导了治疗。组织学上，33.3%的病例为良性，27.6%为癌前病变，37.6%为恶性，1.5%的标本不合格。13个最初被鉴定为良性的病变（8.3%）和37个癌前病变（28.5%）在进一步活检后被发现为恶性。对于浸润性恶性肿瘤/重度发育异常，OBB的敏感性为89.4%，特异性为95.8%，阳性预测值为97.4%，阴性预测值为83.4%，准确性为91.7%。
喉咽病变的门诊活检是安全的，通常耐受性良好，并且在适当的临床环境中提供可靠的诊断结果。OBB上发现的重度发育异常或原位癌应提示怀疑浸润性恶性肿瘤。
