In-Office Transepithelial Laryngeal Brush Biopsy
Otolaryngologists are often faced with a dilemma when relatively non-suspicious tissue is observed in the office during flexible laryngoscopy.
The probability that commonly observed tissue abnormalities are dysplastic is low, while a forceps biopsy to test these lesions presents unavoidable risks and costs. For this reason, forceps biopsy has generally been reserved for those lesions which appear relatively suspicious.
Unfortunately, by the time a lesion appears clinically suspicious, it may have already progressed to a more advanced and less easily treatable stage.
As you know, in the larynx, white or red lesions of the vocal fold and their surrounding structures are common. Repeated biopsies or excision may compromise the patient’s voice if unwanted scarring follows the biopsy. These problems are especially troublesome in preneoplastic lesions or lesions of uncertain behavior that arise from the membranous vocal folds. Repeated excisional biopsies for benign keratosis and mild reactive atypia may be avoided if these lesions can be identified and distinguished from the more aggressive lesions, such as intraepithelial neoplasia or invasive carcinoma.
This is critical since the basal layer is often the only location of dysplasia or carcinoma. The operator should twirl the brush until a small amount of blood or pinkish tissue is noted to ensure a transepithelial biopsy has been achieved.
This localizes potentially abnormal cells and cell clusters through a combined morphological, molecular and DNA ploidy analysis. Potentially abnormal cells and cell clusters are selected by the computer for examination on a high-resolution video monitor by a specially trained pathologist who makes the final diagnosis.
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.
EndoCDx makes obtaining a laryngeal biopsy specimen in unsedated patients possible.