EndoCDx® LP - Laryngeal

In-Office Transepithelial Laryngeal Brush Biopsy

Dr. Shapshay performing EndoCDx Brush Biopsy on Larynx

EndoCDx® LP is a new in-office procedure for otolaryngologists used to identify dysplasia and early stage cancer of the larynx, pharynx, and surrounding tissues.

EndoCDx® consists of an office-based brush biopsy sample of laryngeal tissue, without the need for general anesthesia. The brush biopsy achieves a complete transepithelial sample while limiting penetration into the submucosa, thus avoiding trauma and resulting in minimal bleeding. The specimens are analyzed with the aid of a high speed computer scan which identifies potentially abnormal cells and cell clusters on a high resolution video monitor for specially trained pathologists to review.

EndoCDx® Overview


Each year, approximately 19,000 new cases of laryngeal and pharyngeal cancers are diagnosed in the US. Despite the advances in surgery, radiation therapy, and chemotherapy, the 5-year survival rates for these cancers have essentially remained unchanged for decades and efforts toward early detection of Laryngeal Cancer have not been successful.

A number of obstacles complicate the early detection and diagnosis of dysplasia in the upper aerodigestive tract. Determining the necessity of biopsy by visual inspection of common pharyngeal and laryngeal lesions is associated with limited specificity. That is, very few questionable lesions are found to be either premalignant or malignant when subsequently biopsied. Since biopsy is inconvenient, invasive, and expensive and may be associated with morbidity, especially when performed on vocal cords, only those patients with the most strongly suspicious lesions are referred for a diagnostic biopsy procedure. As a result, patients with ominous, but visually less suggestive lesions may be allowed to progress to a more advanced stage - undiagnosed and untreated.



"Brush biopsies have been an excellent surveillance tool for the detection of premalignant and malignant lesions of the oral cavity. In the larynx, such an approach is used to follow, diagnose, and treat red and white lesions of uncertain behavior."

- Peak Woo, MD



Lesions in the larynx and pharynx are often characterized by a considerable degree of keratinization, especially overlying leukoplakia. As with other upper aerodigestive sites such as the oral cavity, the keratinization prevents a typical cytologic smear, such as that obtained from the bronchus, from sampling cells from the deeper layers of the epithelium. This is critical since the deep layer of the epithelium is often the only layer that contains precancerous and cancerous cells.

EndoCDx®overcomes the obstacles in early detection and prevention of Laryngeal Cancer and is a safe procedure performed in the office setting on unsedated patients during routine office laryngoscopy. Its use in the early detection of dysplasia and carcinoma can potentially result in improving the poor survival rate associated with these cancers.

Transepithelial Brush Biopsy Overview


EndoCDx Brush Biopsy Technique is Simple

Sample Image

After the patient undergoes direct pharyngoscopy and laryngoscopy, with the mucosa readily intubated and clearly visualized, the brush is passed through the channel of a bronchoscope or laryngoscope. A topical anesthetic may be inserted through the operatory chan¬nel of scope prior to inserting the brush.

Retract brush tip into its surrounding sheath and pass down biopsy channel. Place brush tip against lesion and apply firm pres¬sure by angulating the scope. Rotate brush handle and repeatedly pass brush back and forth over lesion until pinpoint bleeding is observed.

Retract brush tip into its surrounding sheath and remove brush from channel. The cellular material is spread from the brush onto the bar-coded side of the enclosed glass slide. The bristle portion of brush is clipped off into enclosed vial for a cell block. The sample is then sent to the CDx for processing and analysis.

Full Transepithelial Sample

Comparison of cells collected by standard biopsy with brush biopsy

Brush biopsies have been an excellent surveillance tool for the detection of premalignant and malignant lesions of the oral cavity. In the larynx, such an approach can be used to follow, diagnose, and treat red and white lesions of uncertain behavior.

  • An office-based biopsy sample
  • No need for general anesthesia
  • Achieves a complete transepithelial tissue sample
  • Brush biopsy limits penetration into the submucosa avoiding trauma
  • Allows accurate and noninvasive evaluation of all lesions identified
  • Identifies dysplasia and cancer even when lesions appear clinically benign

Benefits of the EndoCDx Brush Biopsy

Sample Image

Brush biopsies have been an excellent surveillance tool for the detection of premalignant and malignant lesions of the oral cavity. In the larynx, such an approach can be used to follow, diagnose, and treat red and white lesions of uncertain behavior.

  • An office-based biopsy sample
  • No need for general anesthesia
  • Achieves a complete transepithelial tissue sample
  • Brush biopsy limits penetration into the submucosa avoiding trauma
  • Allows accurate and noninvasive evaluation of all lesions identified
  • Identifies dysplasia and cancer even when lesions appear clinically benign