1. Diagnosis of laryngopharyngeal carcinoma through office-based flexible laryngoscopy as a reliable alternative for biopsies under general anesthesia: Faster diagnostics with equal oncological outcome.
- Author
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Westra JM, Scholman C, Krijnen HK, Zwakenberg MA, van der Vegt B, Schoonbeek RC, Wedman J, Wegner I, Halmos GB, and Plaat BEC
- Subjects
- Humans, Male, Female, Middle Aged, Aged, Biopsy methods, Time Factors, Pharyngeal Neoplasms pathology, Pharyngeal Neoplasms mortality, Pharyngeal Neoplasms diagnosis, Aged, 80 and over, Survival Rate, Adult, Retrospective Studies, Anesthesia, General, Laryngoscopy methods, Laryngeal Neoplasms pathology, Laryngeal Neoplasms diagnosis, Laryngeal Neoplasms mortality, Carcinoma, Squamous Cell pathology, Carcinoma, Squamous Cell diagnosis, Carcinoma, Squamous Cell mortality
- Abstract
Purpose: Diagnostic endoscopy with biopsy under general anesthesia (DE-GA) is still considered as the established standard to assess laryngopharyngeal cancer patients. Office-based flexible laryngoscopic biopsy (FLB) offers an alternative, but the effect on oncological outcome remains uncertain. Therefore, the diagnostic process and survival of patients undergoing FLB, compared to those undergoing DE-GA were evaluated., Methods: Patients suspected of laryngopharyngeal cancer who underwent FLB were evaluated. Patients with FLB-confirmed squamous cell carcinoma (SCC) were matched with DE-GA patients based on tumor site, T-classification, N-classification, age, and p16 overexpression. Time from first visit to diagnosis (FVD), time to treatment interval (TTI), disease-specific survival (DSS) and overall survival (OS) were analyzed., Results: FLB yielded a definitive diagnosis in 155/164 (95 %) patients. No complications were observed. Ninety-eight of the 124 patients in which FLB revealed a SCC received curative treatment and were compared with 98 matched patients who underwent DE-GA. Median FVD interval was 6 days after FLB and 15 days after DE-GA (p < 0.001). Median TTI interval (FLB: 28 days, DE-GA: 28 days) was equal (p = 0.91). Oncological outcomes were comparable (p > 0.05) between FLB (OS: 2-yr: 76 %, 5-yr: 42 %; DSS: 2-yr: 86 %, 5-yr: 85 %) and DE-GA groups (OS: 2-yr: 76 %, 5-yr: 50 %; DSS: 2-yr: 81 %, 5-yr: 79 %)., Conclusion: FLB in the outpatient setting demonstrates a high diagnostic accuracy, is safe, accelerates the diagnostic process and has no negative effects on clinical outcome compared to DE-GA. Therefore, FLB should be considered as the standard diagnostic procedure in patients suspected of laryngopharyngeal cancer., Competing Interests: Declaration of competing interest Boudewijn E. C. Plaat had a consultancy role for Olympus Medical Systems EU. Boudewijn E.C. Plaat and Jeroen M. Westra report an unrestricted grant from Olympus EU (Research funding including contracted research where the institution receives and manages the funds) and part of this Olympus EU grant was used for this study. Bert van der Vegt reports honoraria received by UMCG for expertise or scientific advisory board/consultancy (on request): Visiopharm, Philips, MSD/Merck, Daiichi-Sankyo/AstraZeneca; Speaker's fee from Visiopharm, Diaceutics, MSD/Merck. All unrelated to this publication. The other authors have no other funding, financial relationships, or conflicts of interest to disclose., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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