Outpatient laryngeal biopsy
Topic Status Complete
Laryngeal biopsies in the outpatient setting in people with suspected head and neck dysplasia/cancer
Outcome of the appraisal
The evidence supports the adoption of pharyngolaryngeal biopsy under local anaesthesia to confirm, but not to rule out, a diagnosis of head and neck cancer.
This procedure can be done in an outpatient setting and avoids the need for inpatient care and general anaesthesia. A positive result has the potential to accelerate the initiation of treatment, but a negative result should be followed by a second biopsy in an operating theatre under general anaesthesia.
Economic modelling estimates that there is the potential for cost saving through the use of pharyngolaryngeal biopsy under local anaesthesia rather than in a theatre environment under general anaesthesia and that this is a cost-effective procedure
Why was this topic appraised?
Head and neck cancers are malignancies occurring within the larynx, oral cavity, salivary glands, regions of the pharynx and the paranasal sinuses. If left untreated, the tumour can spread to local and distant areas, most commonly the lymph nodes. In Wales there are around 500 new cases of head and neck cancers reported each year.
The current method for diagnosing patients with suspected head and neck cancer is a biopsy performed in an operating theatre under general anaesthesia. Performing an outpatient biopsy under local anaesthesia could avoid the need for an inpatient biopsy under general anaesthesia as well as reduce the time to diagnosis and time to treatment.
This topic was submitted to Health Technology Wales by Alex Zervakis, General Manager, Health Economics and Market Access, Olympus Medical.
Plain language summary
Head and neck cancer can be found inside the mouth, nose, voice box, throat, salivary glands and sinuses. Symptoms vary according to the nature and location of the cancer. Patients with suspected head and neck cancer are usually seen in outpatient clinics for a diagnostic endoscopy procedure. If the result are uncertain, patients usually must wait for surgery to have a biopsy taken, commonly under general anaesthetic.
A pharyngolaryngeal biopsy takes place in the pharynx (which connects the larynx to the nose and mouth) and the larynx (or voice box). It uses a small instrument to remove a sample of cells from these areas to be examined for signs of cancer. Pharyngolaryngeal biopsies can done under local anaesthetic without needing to wait for a surgery slot, which could lead to a quicker diagnosis of cancer, and could allow for quicker treatment.
HTW look for evidence on the effectiveness of pharyngolaryngeal biopsies for people with suspected head and neck cancer. The evidence supports the adoption of pharyngolaryngeal biopsy under local anaesthesia to confirm, but not to rule out, a diagnosis of head and neck cancer.
Topic Exploration Report
TER304 10.2021
Evidence Appraisal Review
EAR040 04.2022
Guidance
GUI040 05.2022
