• Jacob T Cohen, Ahmad Safadi, Dan M Fliss, Ziv Gil, and Gilad Horowitz.
• Voice and Swallowing Disorders Clinic, Department of Otolaryngology–Head and Neck Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. jacob_cohen@hotmail.com
• JAMA Otolaryngol Head Neck Surg. 2013 Apr 1; 139 (4): 341-5.

ImportanceTransnasal fiberoptic laryngoscopy (TFL) has been used to guide various in-office procedures for the past 3 decades. Publications on in-office laryngeal biopsy have concurred that this procedure is safe, feasible, and easy to perform. However, the accuracy of in-office biopsy via TFL has not yet been established. The aim of this study was to examine this issue.ObjectiveTo compare pathologic results obtained via in-office TFL with those of subsequent direct laryngoscopy to assess the accuracy of TFL as a diagnostic tool.DesignProspective cohort study.SettingTertiary reference medical center.ParticipantsOne-hundred two patients with suspicious laryngeal lesions.InterventionAll patients underwent in-office biopsies.Main Outcome MeasuresAll patients with malignant lesions were referred to appropriate services for treatment, and those with a diagnosis of a benign lesion or carcinoma in situ were referred for direct laryngoscopy for definitive diagnosis. The results of the pathologic testing on specimens from in-office and direct laryngoscopy were compared.ResultsAdequate tissue for diagnostic purposes was obtained in 96 of 102 in-office TFL biopsies (94.1%). The biopsy results revealed invasive carcinoma in 34 patients (35.4%), carcinoma in situ in 17 patients (17.7%), and benign lesions in 45 patients (46.9%). All patients with benign lesions and carcinoma in situ were referred for biopsy of samples obtained using direct laryngoscopy, to which 57 patients agreed. The final pathologic results identified from the biopsies on direct laryngoscopy revealed that there was an underestimation of the TFL results in 30 of 91 patients (false-negative rate, 33.0%) and an overestimation in 1 patient (false-positive rate, 1.1%). The sensitivity of TFL biopsy compared with that of direct laryngoscopy biopsy was 69.2% and the specificity was 96.1%.Conclusions And RelevanceTransnasal fiberoptic laryngoscopy yielded low sensitivity in assessing suspicious lesions of the larynx. These results may indicate that direct laryngoscopy represents the definitive pathologic diagnostic procedure whenever the pathologic results of an in-office TFL procedure are interpreted as benign or as carcinoma in situ.

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