Laryngeal biopsy

Biopsy

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Biopsy of larynx tissue.

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Laryngeal Biopsy - Comprehensive Medical Test Guide

Why is it done?
- Test Purpose: A laryngeal biopsy involves collecting tissue samples from the larynx (voice box) for microscopic examination to diagnose diseases affecting the vocal cords and surrounding structures. This procedure helps identify malignant and benign lesions.
- Primary Indications: Persistent hoarseness lasting more than 2-3 weeks; Suspicious vocal cord lesions visible on laryngoscopy; Suspected laryngeal cancer or malignancy; Chronic voice changes of unknown etiology; Recurrent respiratory papillomatosis; Suspected vocal cord polyps or nodules requiring histological confirmation; Mass or ulceration in the larynx
- Typical Timing: Performed when endoscopic examination reveals abnormal tissue; Usually done during direct or indirect laryngoscopy under controlled conditions; Can be performed in office setting or operating room depending on lesion characteristics; Often scheduled after initial diagnostic laryngoscopy demonstrates concerning findings
Normal Range
- Normal Findings: Benign squamous epithelium; Normal laryngeal mucosa without dysplasia; Absence of malignant cells; Normal keratinization patterns; No inflammation or significant infection
- Result Interpretation Categories: Benign: Non-cancerous findings such as vocal cord polyps, nodules, cysts, or chronic inflammation Dysplasia: Precancerous changes classified as low-grade or high-grade dysplasia Carcinoma: Malignant changes including squamous cell carcinoma or adenocarcinoma Infection/Inflammation: Evidence of fungal, viral, or bacterial infection
- Units of Measurement: Histopathological findings reported qualitatively using standardized terminology; Microscopic examination under light microscopy; Classification based on World Health Organization (WHO) grading system; Results expressed as descriptive histological diagnosis
Interpretation
- Benign Lesions: Vocal cord polyps (non-neoplastic growths); Vocal cord nodules (singer's nodules); Laryngeal cysts; Papillomas (benign viral lesions); Laryngitis or chronic inflammation; Treatment may include voice rest, speech therapy, or surgical removal if symptomatic
- Low-Grade Dysplasia: Precancerous changes with mild cellular abnormalities; Risk of progression to malignancy varies (approximately 5-10% progression risk); Requires close endoscopic surveillance and follow-up biopsies; Smoking cessation strongly recommended; May warrant office-based or laser-assisted removal
- High-Grade Dysplasia: Significant precancerous changes approaching carcinoma in situ; Higher risk of malignant transformation (30-50% progression risk); Requires aggressive management and regular monitoring; Surgical removal often recommended; Follow-up biopsies at 2-3 month intervals typically indicated
- Squamous Cell Carcinoma: Most common laryngeal malignancy (95% of cases); Requires staging studies (CT, MRI) to determine extent; Treatment options include radiotherapy, chemotherapy, or surgical resection; Prognosis depends on stage, grade, and patient factors; Requires multidisciplinary oncology management
- Factors Affecting Results: Smoking history and current smoking status; Alcohol consumption; HPV (Human Papillomavirus) status; Sample adequacy and tissue preservation; Coincident infection or inflammation; Prior radiation therapy; Genetic predisposition; Environmental exposures
Associated Organs
- Primary Organ System: Larynx (voice box) and vocal cords; Respiratory system; Upper aerodigestive tract
- Associated Conditions: Laryngeal cancer (squamous cell carcinoma); Laryngeal dysplasia and premalignant lesions; Recurrent respiratory papillomatosis; Laryngeal papillomas; Vocal cord polyps and nodules; Laryngeal cysts; Laryngitis and chronic inflammation; Laryngeal stenosis; Vocal cord paralysis with secondary changes; Laryngeal web formation
- Diagnostic Applications: Definitively diagnoses malignancy and guides cancer staging; Identifies precancerous changes requiring surveillance or intervention; Determines HPV status which influences treatment decisions; Differentiates benign from malignant lesions; Provides prognostic information based on histologic grade
- Potential Complications: Bleeding from biopsy site (usually minor and self-limited); Laryngeal edema or swelling; Temporary voice changes or hoarseness post-procedure; Rare airway obstruction; Infection at biopsy site; Aspiration risk (managed with appropriate sedation); Vocal cord scarring (uncommon); Vocal cord injury with permanent voice changes (rare)
Follow-up Tests
- For Malignancy: Computed Tomography (CT) of neck and chest for staging; Magnetic Resonance Imaging (MRI) for soft tissue evaluation; Positron Emission Tomography (PET-CT) for metastatic disease assessment; HPV/p16 testing (prognostic value); Oncology consultation; Laryngeal ultrasound for node assessment
- For Dysplasia: Repeat laryngoscopy and biopsy at 2-3 month intervals; Office-based laryngeal examinations; Narrow-band imaging (NBI) endoscopy for enhanced visualization; Consider repeat biopsy if persistent dysplasia detected; HPV testing may guide monitoring strategy
- For Benign Lesions: Voice assessment and speech-language pathology evaluation; Audiologic testing if indicated; Videolaryngeal stroboscopy for voice quality assessment; Follow-up laryngoscopy if symptoms persist; Allergy testing if chronic inflammation suspected
- Monitoring Frequency: Benign lesions: Follow-up as clinically indicated, typically 3-6 months if symptomatic Low-grade dysplasia: Endoscopic surveillance every 3-6 months High-grade dysplasia: Closer monitoring at 2-3 month intervals Carcinoma: Per oncology protocol, typically 1-3 months initially
- Complementary Tests: Direct laryngoscopy under general anesthesia; Flexible fiberoptic laryngoscopy; Voice acoustic analysis; Perceptual voice assessment; Swallow studies if dysphagia present; Immunohistochemistry if available for specific markers
Fasting Required?
- Fasting Status: YES - Fasting is required
- Fasting Duration: NPO (nothing by mouth) for minimum 6-8 hours prior to procedure if general anesthesia planned; If office-based procedure under topical anesthesia: typically 2-4 hours fasting recommended; Clear liquids usually permitted up to 2 hours before procedure in some cases (verify with provider)
- Medications to Avoid: Hold anticoagulants (warfarin, apixaban, rivaroxaban) 24-48 hours prior or per provider instructions; Discontinue antiplatelet agents (aspirin, clopidogrel) 5-7 days before unless contraindicated; Hold NSAIDs for 3-5 days prior to procedure; Discuss all medications with surgeon/anesthesiologist; Continue essential cardiac medications unless specifically instructed otherwise
- Patient Preparation Requirements: Obtain informed consent after discussing risks and benefits; Pre-operative physical examination; Laboratory studies as indicated (CBC, PT/INR, type and cross if significant bleeding anticipated); Anesthesia consultation if general anesthesia planned; Arrange transportation as procedure requires sedation/anesthesia; Avoid smoking for 24 hours prior if possible; Remove dentures, hearing aids, and contact lenses on day of procedure; Wear comfortable, loose-fitting clothing; Arrive early for registration and vital signs assessment; Have responsible adult accompany patient home; Arrange time off work (typically 1-3 days recovery)

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