A systematic review: impact of in-office biopsy on safety and waiting times in head and neck cancer

Abstract

Objective This study aimed to assess the current literature on the safety and impact of in-office biopsy on cancer waiting times as well as review evidence regarding cost-efficacy and patient satisfaction. Method A search of Cinahl, Cochrane Library, Embase, Medline, Prospero, PubMed and Web of Science was conducted for papers relevant to this study. Included articles were quality assessed and critically appraised. Results Of 19 741 identified studies, 22 articles were included. Lower costs were consistently reported for in-office biopsy compared with operating room biopsy. Four complications requiring intervention were documented. In-office biopsy is highly tolerated, with a procedure abandonment rate of less than 1 per cent. When compared with operating room biopsy, it is associated with significantly reduced time-to-diagnosis and time-to-treatment initiation. It is linked to improved overall three-year survival. Conclusion In-office biopsy is a safe procedure that may help certain patients avoid general anaesthetic. It was shown to significantly reduce time-to-diagnosis and time-to-treatment initiation when compared with operating room biopsy. This may have important implications for oncological outcomes. In-office biopsy requires fewer resources and is likely to be cost-saving five-years following introduction. With high rates of sensitivity and specificity, in-office biopsy should be considered as the first-line procedure to achieve tissue diagnosis.

National survey sampling exercise on current practice in channelled local anaesthetic biopsy in suspected head and neck cancer

“…However, most research indicates that LA biopsies are safe, and there are very few major complications reported in the literature. 8 Furthermore, the most common complications, for example bleeding, are minor and often self-limiting.…”

“…A systematic review of the literature found less than 1 per cent of procedures were abandoned because of poor tolerability. 8

Delays in the head and neck cancer pathway result in patients not meeting the 62-day target of referral for treatment In this study, 43 per cent ( n = 25) of respondents were not using local anaesthetic (LA) biopsy with channelled endoscope, but were interested in using it Advantages of LA biopsy include avoiding general anaesthetic and difficult intubation, and faster cancer pathway times Disadvantages of LA biopsy include clinic running late, complications and missing a synchronous primary cancer The main barrier to using LA biopsy is lack of access to channelled flexible endoscopy

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“…Local anaesthetic biopsy can reduce time to diagnosis and avoid unnecessary GA in frail patients. 7,8 However, adoption of this technique has been slow in the UK ENT community, despite its benefits.…”

Screening guidelines for vestibular schwannomas, incidence of significant pathology in nasal polyps, and impact of in-office biopsy in head and neck cancer

“…A systematic review by Lim et al supports the practice of biopsying head and neck tumours. 10 The findings revealed in-office biopsies to be safe and well tolerated. Furthermore, they helped certain patients avoid a general anaesthetic, significantly reduced time-to-diagnosis and time-to-treatment initiation, had high rates of sensitivity and specificity, and are likely to be cost-saving compared with operating theatre biopsies.…”