Trans-oral versus trans-nasal approach in office-based laryngeal biopsy;
a cohort-selection cross-sectional diagnostic accuracy study.
Abstract
Objective: The aim of this study is to explore the accuracy of two
different approaches; trans-oral versus trans-nasal office-based
laryngeal biopsy. Methods: The study was a cohort-selection
cross-sectional study that included all patients aged 18 years or more
with suspicious lesions of the larynx or the oropharynx who came to the
outpatient clinic [removed for blind peer review], due to different
reasons during the period of March 2017 and March 2020. Full evaluation
was done using Flexible naso-endoscope with distal chip. Patients with
suspicious lesions were referred for office-based-based biopsy; either
trans-nasal biopsy or trans-oral biopsy; to determine whether the lesion
was malignant or benign. Then, all patients were referred for subsequent
direct laryngoscopy for definitive diagnosis. Both groups were compared
for all demographic variables as well as clinic-pathologic variables and
for diagnostic accuracy. Results: The overall sample was 60 cases; 30 in
each group. Both groups are comparable with regard the age and gender
(p-values > 0.05). The majority in both groups are smokers
(83.3 & 76.7%). The most frequent cause of referral for biopsy was
suspicious laryngeal mass in both groups; mentioned in 80.0% of both
groups (p-value 0.736). The number of biopsies obtained was
significantly higher in the trans-oral group (3.7 ± 1.0) than in the
trans-nasal group (3.1 ± 0.9), (p-value = 0.013). Both approaches were
tolerated by all patients with few limited aspiration or epistaxis. The
trans-oral approach has a higher Chohen kappa index (0.79) than the
trans-nasal approach (0.14). Also, it has got higher diagnostic accuracy
(93.3%) than the trans-nasal approach (50.0%). The sensitivity of
trans-oral approach biopsies compared with that of direct laryngoscopy
biopsies was 95.8% and the specificity was 83.3%. On the other hand,
the sensitivity of trans-nasal approach biopsies compared with that of
direct laryngoscopy biopsies was 26.3% and the specificity was 90.9%.
Conclusion: The trans-oral approach to obtain a biopsy from the upper
aero-digestive tract has better diagnostic accuracy than the trans-nasal
approach. When combined with trans-nasal visualization and
transcricothyroid anesthesia. Succinct Keypoints: Trans-nasal approach;
trans-oral approach; office-based laryngeal biopsy; sensitivity;
specificity; diagnostic accura