Vocal cord biopsy under local anesthesia, with flexible bronchoscope as an outpatient procedure, by “inside-out” technique

Abstract

Background: Pulmonologists commonly need to take biopsies of laryngeal lesions, either found incidentally while doing bronchoscopy for other indications or while investigating patients for hoarseness of voice and cough. Biopsy of laryngeal lesions has been conventionally done under general anesthesia to provide adequate samples and minimize risks and patient discomfort. Of late, these biopsies have been done as outpatient procedures, by flexible endoscopes, under local anesthesia. However, vocal cord biopsies are often challenging due to poor patient compliance. We have tested an innovative method, which we have called the “inside-out” method, to circumvent this problem. Objectives: We aimed to analyze the feasibility, yield, and the safety of the “inside-out” technique for taking vocal cord biopsies as an outpatient procedure in awake patients. Material and Methods: This was a prospective observational study. Data of 38 patients with vocal cord lesions in whom the above technique was employed were analyzed. Results: The procedure had a diagnostic yield of 78.9% with a sensitivity of 96.7% and a specificity of 100% for detecting malignancy or dysplasia. There were no major complications. Conclusions: The “inside-out” technique was found to be feasible and safe and with a high yield.