xRead - Nasal Obstruction (September 2024) Full Articles

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KUANetal.

TABLE VII.1 Evidence surrounding in-office biopsies for sinonasal lesions.

Clinical endpoints Diagnosis of USD

Study

Year LOE Study design Study groups

Conclusion

Gomes et al. 155

In-office biopsy has a high correlation with final surgical pathology 1. In-office biopsy is an accurate and safe method of diagnosis 2. No complication of in-office biopsy 1. In-office biopsy is a safe diagnostic tool 2. In-office biopsy may provide diagnostic information, but may be limited by accuracy 1. In-office biopsy is safe 2. In-office biopsy is accurate for benign lesions, with limited sensitivity (43.7%) for malignancy In-office biopsy is highly accurate for histopathological diagnosis

2020 3

Retrospective cohort

85 patients underwent in-office punch biopsy followed by surgery 46 patients with USD underwent in-office biopsies, followed by surgery 61 patients underwent in-office biopsy, 25 patients then underwent surgery 521 patients underwent in-office biopsy, followed by surgery 35 patients with USD underwent in-office biopsy, followed by surgery 191 patients with USD Two patients underwent in-office biopsies, followed by surgery

Segal et al. 156

2014 3

Retrospective cohort

Diagnosis of USD

Tabaee et al. 154

Diagnosis of USD

2011

3

Retrospective cohort

Hanet al. 153

2010 3

Retrospective cohort

Diagnosis of USD

Lee 152

Diagnosis of USD

2008 3

Retrospective cohort

Par Silva et al. 157 2015 4

Retrospective cohort

Diagnosis of USD

1. In-office biopsies were not recommended 2. In-office biopsy may incur additional health care costs

Abbreviation: USD, unilateral sinus disease.

candidates for in-office biopsies. Thoughtful patient selec tion and shared decision-making may help clinicians identify appropriate candidates for in-office sinonasal biopsies. Aggregate grade of evidence : D (Level 5: expert opinion, reasoning from first principles) C Technical considerations Some of the above studies also report their biopsy techniques, which are summarized below. 152–155 Prior to considering an in-office biopsy, complete history, nasal endoscopy, and review of available sinonasal imaging should be performed. 152–155 If an in-office biopsy is pur sued, patient vital signs should be assessed prior to, during, and following the procedure. Equipment setup should include the necessary instruments and materi als to manage postbiopsy bleeding that could be severe. After informed consent is obtained from the patient, top ical anesthetics and decongestants can be atomized into

the nose and/or applied on soaked neuropledgets, and local anesthetic may be injected into the biopsy site under direct or endoscopic visualization. If the vascularity of the lesion is a concern, the severity of the bleeding caused by the needle at the injection site may give clinicians an indication of the bleeding risk. Significant bleeding following the injection may indicate a highly vascular lesion and may deter in-office biopsy. For the biopsy, through-cutting instruments were used by several of the study authors, citing a potential risk of increased bleed ing and injury to the surrounding tissue with excessive tissue manipulation. The biopsy site may then be cau terized or packed with absorbable material. If significant bleeding is encountered, nonabsorbable packing mate rial may be required. Clinicians may consider sending both fresh tissue (approximately 1 cm 3 for flow cytome try and IHC to evaluate for lymphoma) and formalin-fixed tissue. Aggregate grade of evidence : D (Level 5: expert opinion, reasoning from first principles)