In-office cup biopsy and laryngeal cytology versus operating room biopsy for the diagnosis of pharyngolaryngeal tumors: Efficacy and cost-effectiveness

Abstract

Background: In-office biopsy is an effective technique to diagnose the nature of pharyngolaryngeal lesions.

Methods: We selected patients with pharyngolaryngeal lesions suspicious for malignancy. For in-office biopsy procedures, laryngeal cytology and direct laryngoscopy biopsy were performed, and diagnostic parameters and costs were estimated.

Results: Eighty-eight patients were selected for this study. For laryngeal cytology, sensitivity was 70.3% (95% confidence interval [CI] = 59.9% to 80.7%), specificity 100% with a positive predictive value of 100% and a negative predictive value of 50% (95% CI = 35.2% to 64.8%). In-office biopsy sensitivity was 81% (95% CI = 72.6% to 89.3%), specificity 100% with a positive predictive value of 100% and a negative predictive value of 20% (95% CI = 2.5% to 37.5%). At our hospital, the use of in-office biopsies as a first approach for diagnosis saves $50,140.80 U.S. per annum.

Conclusion: In-office biopsy is a more affordable technique that enables histologic diagnosis of pharyngolaryngeal lesions in a large percentage of patients.

Keywords: ambulatory surgical procedures; biopsy; cost-benefit analysis; cytology; head and neck neoplasms.