Indications, technique, safety, and accuracy of office-based nasal endoscopy with biopsy for sinonasal neoplasm

Office-based nasal endoscopy with biopsy may provide histopathological diagnosis in patients with sinonasal neoplasms while avoiding operative biopsy. The objective of this study was to describe the technique, safety, and accuracy of office-based nasal endoscopy with biopsy for a primary indication of sinonasal neoplasm.

A retrospective review of the indications, complications, and results of office-based nasal endoscopy with biopsy for primary indication of neoplasm was performed. When available, comparison was made between the histopathological findings at biopsy vs surgery.

A total of 61 patients underwent 69 office-based endoscopic sinonasal biopsies during the 3-year study period. The results of the biopsies in this cohort included inflammatory changes in 36 procedures (52%), benign neoplasm in 14 procedures (20%), malignant lesion in 12 procedures (17%), nondiagnostic tissue in 5 specimens (7%), and granulomatous/vasculitic lesion in 2 procedures (3%). Comparison of office biopsy vs surgery in 28 procedures (25 patients) revealed agreement in 23 procedures (82%), 2 false-negative results for malignancy, 1 false-negative result for hemangioma, and 1 false-negative result and 1 false-positive result each for inverted papilloma. Accuracy analysis for a diagnosis of neoplasm yielded a sensitivity of 71%, specificity of 93%, false-positive rate of 9%, and false-negative rate of 24%. No major complications were experienced.

Office-based nasal endoscopy with biopsy represents a safe and important diagnostic tool in the evaluation of sinonasal neoplasms. The procedure is generally safe and provides diagnostic information that may alter treatment decisions. Limitations of the procedure do exist, notably issues related to accuracy.