Diagnostic Accuracy Outcomes of Office-Based (Outpatient) Biopsies in patients with Laryngopharyngeal Lesions: A Systematic Review

Mervyn Owusu-Ayim (Lead / Corresponding author), Sushil R. Ranjan, Alison E. Lim, Alexander D. G. Rogers, Jenny Montgomery, Susanne Flach, Jaiganaesh Manickavasagam

Research output: Contribution to journalReview articlepeer-review

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Introduction: In-office biopsy (IOB) using local anaesthetic for laryngopharyngeal tumours has become an increasingly popular approach since the advent of distal chip endoscopes. Although a wide range of studies advocate use in clinical practice, the widespread application of the procedure is hampered by concerns regarding diagnostic accuracy.

Methods: A systematic review following the PRISMA guidelines was conducted to assess the diagnostic accuracy of IOBs performed via flexible endoscopy. In addition, an analysis of potentially modifiable factors that may affect diagnostic accuracy was performed. PubMed, EMBASE, The Cochrane Library, Web of Science, CINAHL were used in the literature database search.

Results: 875 studies were identified, 16 of which were included into the systematic review. 1572 successful biopsies were performed using flexible endoscopy. 1283 cases were accurately diagnosed in the outpatient setting (81.6%). 289 samples did not provide an accurate diagnosis (18.4%). The median sensitivity of IOBs was 73%, the specificity was 96.7%. Analysis of variable factors did not show any significant differences in method of approach, size of equipment (forceps), additional lighting system or learning curve.

Conclusion: IOBs are a viable tool for diagnostic workup of laryngopharyngeal tumours. Clinicians should be wary of reported limitations of IOBs when benign or pre-malignant diagnoses are made. In cases suspicious of malignancy, confirmatory investigation should be conducted.

Original languageEnglish
Number of pages15
JournalClinical Otolaryngology
Early online date23 Nov 2021
Publication statusE-pub ahead of print - 23 Nov 2021


  • Flexible Endoscopy
  • In-Office Biopsy (IOB)
  • Laryngopharyngeal Lesions
  • Outpatient Biopsy
  • Systematic Review


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