title: The utility of office-based biopsy for laryngopharyngeal lesions: comparison with surgical evaluation.
abstract: OBJECTIVE
  Advances in flexible endoscopy with working-channel biopsy forceps have led to excellent visualization of laryngopharyngeal lesions with capability for in-office awake biopsy. Potential benefits include prompt diagnosis without risk of general anesthesia, preoperative counseling, and avoiding an anesthetic should the lesion return benign. We evaluate the accuracy of these biopsies in order to determine their role and diagnostic value.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Medical records were reviewed from January 1, 2010, through July 31, 2013, of patients who underwent office-based current procedural terminology code 31576 and were taken to the operating room for direct microlaryngoscopy with biopsy/excision. Clinical diagnoses and pathology reports were reviewed. For statistical analysis, we considered three groups: 1) malignant and premalignant, 2) lesions of uncertain significance, and 3) benign lesions.
  
  
  RESULTS
  In the study period, 76 patients with an office biopsy had a clinical picture to warrant direct microlaryngoscopy and biopsy/excision. Kendall's coefficient for each group indicated moderate correlation only. When groups 1 and 2 were considered together, there was a substantial and statistically significant correlation. For malignant and premalignant lesions, the office biopsy analysis was as follows: sensitivity = 60%, specificity = 87%, positive predictive value = 78%, and negative predictive value = 74%.
  
  
  CONCLUSIONS
  Office biopsy may offer early direction and avoid operative intervention in some cases; however, for suspected dysplastic or malignant lesions, direct microlaryngoscopy should be the standard of care to ensure adequate full-thickness sampling and staging. For benign pathology, office biopsy is a safe and viable alternative to direct microlaryngoscopy and biopsy/excision.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine, Mount Sinai Hospital, New York, New York, U.S.A.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Richards
authors.forename: Manikandan
authors.initials: M
authors.lastname: Sugumaran
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Aviv
authors.forename: Peak
authors.initials: P
authors.lastname: Woo
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Altman
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data*; D001707:Biopsy, Needle / Q000191:economics / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007818:Laryngeal Diseases / Q000473:pathology / Q000601:surgery; D007822:Laryngeal Neoplasms / Q000473:pathology* / Q000601:surgery; D007828:Laryngoscopy / Q000379:methods; D008297:Male; D008499:Medical Records; D009873:Operating Rooms / Q000191:economics / Q000706:statistics & numerical data*; D010610:Pharyngeal Neoplasms / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity
keywords: Office biopsy; dysplasia; lesion; leukoplakia; medical decision making; microlaryngoscopy