MULTIPLE BIOPSIES IN LARYNGEAL CARCINOMAS

Background: The fate of patients suffering from laryngeal carcinoma is influenced strongly by the stage of the tumor at the time of diagnosi s. This factor is also critical for preservation of the organ. It may be impossible to diagnose the tumor with the first biopsy even though the clinical and macroscopic aspect suggests a malignancy. Methods: In a retrospective study, we examined 468 patients with laryngeal carcin oma who were treated at the departments of otorhinolaryngology at the University of Basel (B) (198 patients from 1983-1992) or in Giessen (G ) (270 from 1990-1995). The number of biopsies necessary to confirm th e diagnosis was analysed and the follow-up of the patients was evaluat ed. Thirty of 32 negative histologic samples were reexamined. Results: Of 468 patients, 32 (7%, 27 [B] 14%; and 5 [G] 2%) required two to si x biopsies to confirm the clinically suspected diagnosis: Twenty patie nts (designated as Group 1) were diagnosed within one to three months, and no patient showed a change of tumor stage within that time. Their first biopsies have to be considered as ''nonrepresentative''. Eight patients (Group 2) were diagnosed within four to 24 months and four pa tients (Group 3) more than 24 months after the first biopsy. Final tre atment and outcome in patients from Group 1 was unchanged by the time delay in diagnosing the tumor. Seven of eight patients in Group 2 expe rienced an obvious progression of their tumor during the diagnostic pe riod, which led to laryngectomy in several cases. In four patients, di agnosis was confirmed more than two years after the first biopsy. Thes e were special cases such as development of cancer out of a papillomat osis or chronic laryngitis. Conclusions: A time delay of three months in diagnosing cancer of the larynx does not have a significant influen ce on organ preservation and prognosis, even though especially in smal l tumors suspicion of cancer should lead to a new representative biops y as fast as possible to preserve the larynx.