In-office laryngeal and pharyngeal biopsies offer a safe, efficient and cost-minimising alternative15 to standard methods for diagnosing patients with suspected laryngeal, oropharyngeal and hypopharyngeal lesions under general anaesthesia14.
Thanks to major improvements in flexible rhinolaryngoscopes with a working channel, it is now possible to perform several therapeutic procedures such as obtaining biopsy samples in your otorhinolaryngology office, among others17.
Why should you consider the in-office biopsy alternative?
Biopsies under general anaesthesia may be associated with:
- Risks connected to general anaesthesia12
- Higher demands of resources and accompanying costs2,3,10
- A long and complex patient pathway from diagnosis to treatment2,15,16
“Office-based biopsy under local anaesthesia using flexible digital video laryngoscopy is safe, cost-effective and successful in providing a histopathological diagnosis"15.
3 reasons to consider the in-office biopsy alternative
With in-office biopsies, patients avoid the risks associated with general anaesthesia and get a quicker diagnosis – and hence a shorter time to treatment – while the hospital saves scarce variable resources 5,7.
1. Quick treatment
It is possible to perform an in-office biopsy as early as the first visit12. When faced with limited resources and a long waiting list, this can relieve the burden in the OR6,8.
2. Safe and efficient patient pathway*
Evidence of safety is supported by low complication rates and high tolerability3,4,9. Efficiency of in-office biopsies is supported by the high specificity13.
3. Improved patient experience and outcome
Patients avoid the risks associated with general anaesthesia12 – especially relevant for cases of significant comorbidity16. Furthermore, evidence indicates that a faster result reduces patient anxiety2. Finally, a faster time to diagnosis and treatment start enhances the outcome15,16.
*Please note that a lower sensitivity is prevalent, indicating that if the results appear negative, the patient might require a new biopsy under general anaesthesia to confirm the findings2,14. Hence, it is the responsibility of the clinician to refer for further examination if deemed appropriate.
How in-office biopsies minimize costs
Several cost studies have demonstrated lower costs with in-office biopsies as compared to biopsy under general anaesthesia2,3,10.
Current versus new
Rethink your care process, consider implementing organizational changes in your practice.
1. General anaesthesia biopsy resources eliminated
The costs of the operating theatre, anaesthesia and anaesthesiologist, and recovery room are eliminated10,11,16.
2. Less waiting time is considered cost-effective
A reduction in both waiting time to diagnosis and time to treatment improves patient outcome and is cost-minimizing compared to the current practice15,16,8.
Ambu® aScope™ 4 RhinoLaryngo Intervention
The ideal solution for in-office biopsies
With the channelled single-use aScope 4 RhinoLaryngo Intervention (which is ideally suited for therapeutic interventions, such as biopsies) and the aView 2 Advance HD monitor, you can rely on:
- Navigating in the upper airway and identifying anatomical structures confidently
- Easy-to-record video and images, and documenting them via connectivity to PACS
- Continuous availability of channelled scopes whenever needed
- No turnover time for reprocessing and cleaning
Cost-minimising and transparent single-use concept6,11, 12
- Cost directly linked to volume of patients
- No significant investment on capital equipment
- No repair costs
Becker, S., Hagemann, J., O'Brian, C., Weber, V., Döge, J., Helling, K., & Ernst, B. (2019). First experiences with a new flexible single-use rhino-laryngoscope with working channel - a preliminary study. Abstract- Und Posterband – 90. Jahresversammlung Der Deutschen Gesellschaft Für HNO-Heilkunde, Kopf- Und Hals-Chirurgie E.V., Bonn – Digitalisierung In Der HNO-Heilkunde. doi: 10.1055/s-0039-1685699.
Castillo Farías, F., Cobeta, I., Souviron, R., Barberá, R., Mora, E., Benito, A. and Royuela, A., 2015. In-office cup biopsy and laryngeal cytology versus operating room biopsy for the diagnosis of pharyngolaryngeal tumors: Efficacy and cost-effectiveness. Head & Neck, 37(10), pp.1483-1487.
Cha, Wonjae, Byung Woo Yoon, Jeon Yeob Jang, Jin Choon Lee, Byung Joo Lee, Soo Geun Wang, Jae Keun Cho, and Ilyoung Cho. 2016. “Office-Based Biopsies for Laryngeal Lesions: Analysis of Consecutive 581 Cases.” Laryngoscope 126(11):2513–19.
Cohen JT, Bishara T, Trushin V, Benyamini L. Adverse Events and Time to Diagnosis of In-Office Laryngeal Biopsy Procedures. Otolaryngol Head Neck Surg. 2018 Jul;159(1):97-101. doi: 10.1177/0194599818764412. Epub 2018 Mar 13. PMID: 29533699.
Fang TJ, Li HY, Liao CT, Chiang HC, Chen IH. Office-based narrow band imaging-guided flexible laryngoscopy tissue sampling: a cost-effectiveness analysis evaluating its impact on Taiwanese health insurance program. J Formos Med Assoc. 2015;114(7):633-638.
Han, A., Miller, J., Long, J., & St John, M. (2020). Time for a Paradigm Shift in Head and Neck Cancer Management During the COVID-19 Pandemic. Otolaryngology–Head and Neck Surgery, 163(3), 447-454. doi: 10.1177/0194599820931789.
Leboulanger, N., Celerier, C., Thierry, B., & Garabedian, N. (2016). How to perform endoscopy in paediatric otorhinolaryngology? European Annals Of Otorhinolaryngology, Head And Neck Diseases, 133(4), 269-272. doi: 10.1016/j.anorl.2016.03.002.
Lee, Francisco, Kristine A. Smith, Shamir Chandarana, T. Wayne Matthews, J. Douglas Bosch, Steven C. Nakoneshny, and Joseph C. Dort. 2018. “An Evaluation of In-Office Flexible Fiber-Optic Biopsies for Laryngopharyngeal Lesions.” Journal of Otolaryngology - Head and Neck Surgery 47(1):1–5.
Lippert, Dylan, Matthew R. Hoffman, Phat Dang, Timothy M. McCulloch, Gregory K. Hartig, and Seth H. Dailey. 2015. “In-Office Biopsy of Upper Airway Lesions: Safety, Tolerance, and Effect on Time to Treatment.” Laryngoscope 125(4):919–23.
Marcus, S., M. Timen, Gregory R. Dion, Mark A. Fritz, Ryan C. Branski, and Milan R. Amin. 2019. “Cost Analysis of Channeled, Distal Chip Laryngoscope for In-Office Laryngopharyngeal Biopsies.” Journal of Voice 33(4):575–79.
Naidu, Harini, J. Pieter Noordzij, Arang Samim, Scharukh Jalisi, and Gregory A. Grillone. 2012. “Comparison of Efficacy, Safety, and Cost-Effectiveness of in-Office Cup Forcep Biopsies versus Operating Room Biopsies for Laryngopharyngeal Tumors.” Journal of Voice 26(5):604–6.
Richards, Amanda L., Manikandan Sugumaran, Jonathan E. Aviv, Peak Woo, and Kenneth W. Altman. 2015. “The Utility of Office-Based Biopsy for Laryngopharyngeal Lesions: Comparison with Surgical Evaluation.” Laryngoscope 125(4):909–12.
R. Rodellar and R. Russell, “Upper airway biopsy cost-effectiveness analysis: Outpatient clinic vs. operating theatre,” Value Heal., vol. 23, no. 12, 2020, [Online]. Available: https://europe2020-ispor.ipostersessions.com/Default.aspx?s=79-EA-B2-D9-3D-CC-14-22-CA-57-AF-60-CD-61-77-97.
Saga, C., Olalde, M., Larruskain, E., Álvarez, L., & Altuna, X. (2017). Application of Flexible Endoscopy-Based Biopsy in the Diagnosis of Tumour Pathologies in Otorhinolaryngology. Acta Otorrinolaringologica (English Edition), 69(1), 18-24. doi: 10.1016/j.otoeng.2017.12.008.
Schutte, Henrieke W., Robert P. Takes, Piet J. Slootweg, Marianne J. P. A. Arts, Jimmie Honings, Frank J. A. van den Hoogen, Henri A. M. Marres, and Guido B. van den Broek. 2018. “Digital Video Laryngoscopy and Flexible Endoscopic Biopsies as an Alternative Diagnostic Workup in Laryngopharyngeal Cancer: A Prospective Clinical Study.” Annals of Otology, Rhinology and Laryngology 127(11):770–76.
Simons, Pascale A. M., Bram Ramaekers, Frank Hoebers, Kenneth W. Kross, Wim Marneffe, Madelon Pijls-Johannesma, and Dominique Vandijck. 2015. “Cost-Effectiveness of Reduced Waiting Time for Head and Neck Cancer Patients Due to a Lean Process Redesign.” Value in Health 18(5):587–96.
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