UW-Madison School of Medicine and Public Health: In-office biopsy speeds treatment of head and neck cancer

CONTACT: Susan Lampert Smith, (608) 890-5643, [email protected]

Madison — Doing biopsies of suspected head and neck cancers in the physician’s office is not only less expensive – a successful diagnosis can cut the time to cancer treatment in half.

Researchers led by Dr. Seth Dailey, associate professor of surgery in the University of Wisconsin School of Medicine and Public Health, looked at the outcomes of 116 patients who had in-office biopsies of lesions on their tongue base, larynx or the back of the throats. Such diagnostic procedures used to be performed under anesthesia in an operating room, but otolaryngologists are increasingly doing these procedures in their offices.

In general, this study found that the procedures were well tolerated by patients, with only two unable to complete the procedure, and produced no complications. The study found that a successful office biopsy led to treatment for head and neck cancer in an average of 24 days, compared with an average of 48 days for those who had to wait for a surgical appointment in an operating room.

“In more aggressive types of cancer, a tumor can grow quickly in a month’s time, so we think this is an important benefit of the in-office biopsy,” says Dr. Dailey. “In future studies, we should look at whether quicker diagnosis affects survival rates or recurrence of the cancers.”

For the in-office biopsy, the physician uses a local anesthetic such as lidocaine spray and places a telescope into the throat via either the nose or the mouth. Once the lesion is in view, the physician takes a sample using a biopsy forceps that is passed through the channel of the scope. Of the patients in the study, 97 of the 116 had diagnoses made in the office. The rest needed a second office biopsy, or a biopsy in the operating room.

An earlier study estimated that the cost of an office biopsy was about $2,054 compared with $9,024 for a biopsy in the operating room.

The in-office biopsies found 43 nonmalignant lesions and 62 malignant squamous-cell lesions. Another 17 patients had office biopsies that indicated nonmalignant changes, but later operative or in-office biopsies showed that 15 had squamous cell cancer and two had lymphoma. Dailey says these false negatives should be cautionary.

“There’s no substitute for sound clinical judgment,” Dailey says. “If a physician strongly suspects cancer, a second office or operative biopsy is warranted.”

Co-authors on the study were Drs. Dylan Lippert, Matthew Hoffman, Phat Dang, Timothy M. McCulloch and Gregory Hartig, all of the Department of Surgery’s division of Otolaryngology. The research was published recently in the journal The Laryngoscope and is available here: http://www.ncbi.nlm.nih.gov/pubmed/25376857