title: Comparison of efficacy, safety, and cost-effectiveness of in-office cup forcep biopsies versus operating room biopsies for laryngopharyngeal tumors.
abstract: OBJECTIVE
  To compare the diagnostic yield, safety, and cost of biopsies of laryngopharyngeal tumor performed in an office setting with those performed in the operating room (OR) under general anesthesia.
  
  
  METHODS
  This was a retrospective review of patients' records at Boston Medical Center from 2006 to 2008.
  
  
  METHODS
  In-office biopsies were performed using flexible digital videolaryngoscopy with cup forcep biopsies taken via the working channel in patients in whom cancer was strongly suspected. Patients whose in-office biopsies were nondiagnostic or suspected to be falsely negative were taken to the OR for biopsy under general anesthesia and served as the control group.
  
  
  RESULTS
  Twelve patients fit the selection criteria and had in-office biopsies attempted. One patient could not tolerate the in-office biopsy. Seven of the 11 in-office biopsies performed were diagnostic for squamous cell carcinoma. The average cost (facility and professional otolaryngology charges) for an in-office biopsy was $2053.91. Five of these patients required further biopsy in the OR at an average cost (charges for surgeon, OR, anesthesia, and recovery room) of $9024.47. There were no significant complications reported for any of the procedures.
  
  
  CONCLUSIONS
  In patients with strongly suspected laryngopharyngeal cancer, in-office cup forcep biopsies were 64% diagnostic. When compared with the OR, in-office cup biopsies of laryngopharyngeal tumor are safe and considerably more cost-effective. Although 36% of patients required operative biopsies, the cost would have been considerably higher in this cohort if all patients had gone to the OR for biopsies.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, Boston, Massachusetts 02118, USA.
authors.forename: Harini
authors.initials: H
authors.lastname: Naidu
authors.forename: J Pieter
authors.initials: JP
authors.lastname: Noordzij
authors.forename: Arang
authors.initials: A
authors.lastname: Samim
authors.forename: Scharukh
authors.initials: S
authors.lastname: Jalisi
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Grillone
mesh_terms: D000768:Anesthesia, General / Q000191:economics; D001706:Biopsy / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation / Q000379:methods; D001900:Boston; D002294:Carcinoma, Squamous Cell / Q000191:economics / Q000473:pathology*; D003362:Cost-Benefit Analysis; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007013:Hypopharynx / Q000473:pathology*; D007822:Laryngeal Neoplasms / Q000191:economics / Q000473:pathology*; D007828:Laryngoscopy / Q000191:economics; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000191:economics; D009819:Office Visits / Q000191:economics*; D009873:Operating Rooms / Q000191:economics*; D061214:Patient Safety; D010610:Pharyngeal Neoplasms / Q000191:economics / Q000473:pathology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013525:Surgical Instruments / Q000191:economics*; D014741:Video Recording / Q000191:economics