Skip to main content
SpringerLink
Log in

NBI flexible laryngoscopy targeted tissue sampling in head and neck cancer patients with difficult airways

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Direct suspension laryngoscopic biopsy of neoplasms in larynx, oropharynx, and hypopharynx was an arduous procedure in patients with a history of head and neck cancer and difficult airways. This preliminary study was aimed to report the efficacy and safety of a narrow band imaging-guided biopsy of this category by flexible laryngoscopy. This is a retrospective chart review study conducted in setting of tertiary referral centre. Nineteen consecutive head and neck cancer patients with difficulty in general anesthesia and rigid endoscopic approach due to trismus, craniofacial deformities, and/or limited neck extension after cancer therapy were referred for endoscopic biopsy of their suspicious lesions in larynx, hypopharynx, or parts of oropharynx. Following topical anesthesia, a flexible laryngoscope was introduced through the nose into the pharynx. Under narrow band imaging magnified view, the specified tumor foci were biopsied in an office-based setting. All of the lesions were reached and biopsied to obtain sufficient tissue samples. The procedure took <20 min in every case. Twelve of the 19 pathologic examinations disclosed the malignancies at the first biopsy, and another underwent a second biopsy to prove cancer recurrence. The other six patients with benign lesions received further follow-up for at least 6 months and showed no recurrence. There were no complications associated with the technique. This study introduced that flexible laryngoscopy with narrow band imaging has the advantages of nimbleness, precision, and minimal morbidity. This combined technique may be a safe and promising method for tissue sampling of suspicious recurrence in head and neck cancer patients with difficult airways.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Ridge JA, Glisson BS, Lango MN, Feigenberg S. (2004) Head and neck tumor. In: Pazdur R, Wagman LD, Camphausen KA, Hoskins WJ (eds) Cancer Management, 13th edn. UBM Medica, Norwalk, CT. http://www.cancernetwork.com/display/article/10165/1802498. Accessed July 2011

  2. Chang MFT, Wang HM, Kang CJ et al (2010) Treatment results for hypopharyngeal cancer by different treatment strategies and its secondary primary—an experience in Taiwan. Radiat Oncol 5:91

    Article  PubMed  Google Scholar 

  3. Liao CT, Chang JT, Wang HM et al (2008) Analysis of risk factors predictive of local tumor control in oral cavity cancer. Ann Surg Oncol 15:915–922

    Article  PubMed  Google Scholar 

  4. Wheeler M, Ovassapian A (2007) Fiberoptic endoscopy-aided techniques. In: Hagberg CA (ed) Benumof’s airway management: principles and practice. Elsevier/Mosby/Saunders, Philadelphia, pp 399–438

    Google Scholar 

  5. American Society of Anesthesiologists Task Force on Management of the Difficult Airway (2003) Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 98(5):1269–1277

    Article  Google Scholar 

  6. Hall CE, Shutt LE (2003) Nasotracheal intubation for head and neck surgery. Anaesthesia 58:249–256

    Article  PubMed  CAS  Google Scholar 

  7. Hao SP, Chen HC, Wei FC, Chen CY, Yeh AR, Su JL (1999) Systematic management of osteoradionecrosis in the head and neck. Laryngoscope 109:1324–1327

    Article  PubMed  CAS  Google Scholar 

  8. Zbären P, Caversaccio M, Thoeny HC, Nuyens M, Curschmann J, Stauffer E (2006) Radionecrosis or tumor recurrence after radiation of laryngeal and hypopharyngeal carcinomas. Otolaryngol Head Neck Surg 135:838–843

    Article  PubMed  Google Scholar 

  9. Piazza C, Cocco D, De Benedetto L, Del Bon F, Nicolai P, Peretti G (2010) Narrow band imaging and high definition television in the assessment of laryngeal cancer: a prospective study on 279 patients. Eur Arch Otorhinolaryngol 267:409–414

    Article  PubMed  Google Scholar 

  10. Wolters U, Wolf T, Stützer H, Schröder T (1996) ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth 77:217–222

    Article  PubMed  CAS  Google Scholar 

  11. Bureau of Health Promotion (2007) Taiwan cancer registry: annual report (Chinese version). http://www.bhp.doh.gov.tw/. Accessed March 2011

  12. León X, Quer M, Diez S, Orús C, López-Pousa A, Burgués J (1999) Second neoplasm in patients with head and neck cancer. Head Neck 21:204–210

    Article  PubMed  Google Scholar 

  13. Morris LG, Sikora AG, Patel SG, Hayes RB, Ganly I (2011) Second primary cancers after an index head and neck cancer: subsite-specific trends in the era of human papillomavirus-associated oropharyngeal cancer. J Clin Oncol 29:739–746

    Article  PubMed  Google Scholar 

  14. Vissink A, Jansma J, Spijkervet FK, Burlage FR, Coppes RP (2003) Oral sequelae of head and neck radiotherapy. Crit Rev Oral Biol Med 14:199–212

    Article  PubMed  CAS  Google Scholar 

  15. Wang CJ, Huang EY, Hsu HC, Chen HC, Fang FM, Hsiung CY (2005) The degree and time-course assessment of radiation-induced trismus occurring after radiotherapy for nasopharyngeal cancer. Laryngoscope 115:1458–1460

    Article  PubMed  Google Scholar 

  16. Teguh DN, Levendag PC, Voet P et al (2008) Trismus in patients with oropharyngeal cancer: relationship with dose in structures of mastication apparatus. Head Neck 30:622–630

    Article  PubMed  Google Scholar 

  17. Dijkstra PU, Kalk WW, Roodenburg JL (2004) Trismus in head and neck oncology: a systematic review. Oral Oncol 40:879–889

    Article  PubMed  CAS  Google Scholar 

  18. Rajalalitha P, Vali S (2005) Molecular pathogenesis of oral submucous fibrosis—a collagen metabolic disorder. J Oral Pathol Med 34:321–328

    Article  PubMed  CAS  Google Scholar 

  19. Gono K, Obi T, Yamaguchi M et al (2004) Appearance of enhanced tissue features in narrow-band endoscopic imaging. J Biomed Opt 9:568–577

    Article  PubMed  Google Scholar 

  20. Watanabe A, Tsujie H, Taniguchi M, Hosokawa M, Fujita M, Sasaki S (2006) Laryngoscopic detection of pharyngeal carcinoma in situ with narrowband imaging. Laryngoscope 116:650–654

    Article  PubMed  Google Scholar 

  21. Lin YC, Watanabe A, Chen WC, Lee KF, Lee IL, Wang WH (2010) Narrowband imaging for early detection of malignant tumors and radiation effect after treatment of head and neck cancer. Arch Otolaryngol Head Neck Surg 136:234–239

    Article  PubMed  Google Scholar 

  22. Muto M, Katada C, Sano Y, Yoshida S (2005) Narrow band imaging: a new diagnostic approach to visualize angiogenesis in superficial neoplasia. Clin Gastroenterol Hepatol 3:S16–S20

    Article  PubMed  Google Scholar 

  23. Watanabe A, Tsujie H, Taniguchi M, Hosokawa M, Fujita M, Sasaki S (2006) Laryngoscopic detection of pharyngeal carcinoma in situ with narrowband imaging. Laryngoscope 116:650–654

    Article  PubMed  Google Scholar 

  24. Matsuba H, Katada C, Masaki T et al (2011) Diagnosis of the extent of advanced oropharyngeal and hypopharyngeal cancers by narrow band imaging with magnifying endoscopy. Laryngoscope 121:753–759

    Article  PubMed  Google Scholar 

  25. Harris AH, Smith RR (1960) Operative wound seeding with tumor cells: its role in recurrences of head and neck cancer. Ann Surg 151:330–334

    Article  PubMed  CAS  Google Scholar 

  26. Keim WF, Shapiro MJ, Rosin HD (1965) Study of postlaryngectomy stomal recurrence. Arch Otolaryngol 81:183–186

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors appreciated the members of Head and Neck Oncology Group of Chang Gung Memorial Hospital, Linkou Medical Center for their great supports.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital, 5, Fu-Shin Street, Kweishan, 333, Taoyuan, Taiwan

    Chung-Tsung Pan, Li-Ang Lee, Tuan-Jen Fang, Hsueh-Yu Li, Chun-Ta Liao & I-How Chen

  2. School of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan

    Chung-Tsung Pan, Li-Ang Lee, Tuan-Jen Fang, Hsueh-Yu Li, Chun-Ta Liao & I-How Chen

Authors
  1. Chung-Tsung Pan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Li-Ang Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tuan-Jen Fang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hsueh-Yu Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chun-Ta Liao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. I-How Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tuan-Jen Fang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pan, CT., Lee, LA., Fang, TJ. et al. NBI flexible laryngoscopy targeted tissue sampling in head and neck cancer patients with difficult airways. Eur Arch Otorhinolaryngol 270, 263–269 (2013). https://doi.org/10.1007/s00405-012-1989-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-012-1989-4

Keywords

Search

Navigation