Patients with discrete suspicious-appearing lesions were eligible for inclusion in this study. Suspicious lesionsincluded: leukoplakia, erythroplakia, ulceration, a cauliflower appearance, and a lesion on an immobile vocal cord, thus excluding patients with benign-appearing lesions, such as polyps, nodules, Reinke’s space edema, and findings compatible with chronic laryngitis due to reflux. Patients with suspicious lesions were referred Inhibitors,research,lifescience,medical for TFL biopsy in order to determine find more whether the lesion was malignant or benign. The pathologic diagnosis of invasive carcinoma from a TFL biopsy was considered equivalent to the pathology results from a direct laryngoscopy

biopsy. All patients with benign pathology Inhibitors,research,lifescience,medical or carcinoma in situ (CIS), however, were referred to subsequent direct laryngoscopy for definitive diagnosis. CIS results were added to invasive carcinoma results when sensitivity and specificity measurements were calculated. Pathological

results of the specimens from both procedures were compared. All relevant demographic and clinical data Inhibitors,research,lifescience,medical were retrieved for analysis. The study was approved by the institutional ethics committee, and all suitable patients signed an informed consent form prior to undergoing the procedure. Biopsy Technique We use a Pentax-FNL-10 RP3 (Montvale, NJ, USA) and ENT 2000-vision sciences (Orangeburg, NY, USA) for performing flexible TFL. The endoscope is connected proximally to a camera and Inhibitors,research,lifescience,medical monitor. The soft palate is locally anesthetized with 10% xylocaine spray, and the nasal cavity is anesthetized with 2% tetracaine mixed with 0.05% oxymetazoline HCl. The endoscope is covered with a disposable plastic sheath that has a working channel (ENT slide-on Endo-sheath system, Medtronic, Minneapolis, MN, USA). A 2-mm diameter biopsy forceps is inserted through the working channel (Laryngeal Biopsy Forceps, Medtronic, Minneapolis, MN, USA). After insertion of the endoscope, 2 mL of 2% lidocaine is injected through

the working channel. In some cases Inhibitors,research,lifescience,medical more than one biopsy specimen was collected in order to sample different parts of the lesion. The tissue was collected in a designated pathology plastic cup containing 0.9% NaCl solution. The patients remained for Ketanserin observation in the clinic for 30 minutes after undergoing the procedure. RESULTS A total of 117 patients that underwent in-office biopsies for suspicious-appearing lesions in the larynx participated in the study. The group included 94 males and 23 females with a median age of 66 years (range 30–89 years). The most common presenting symptom was dysphonia (66.6%, n= 78). Other symptoms included dysphagia, chronic cough, throat discomfort, and dyspnea. Sixty-six patients (56.4%) had additional co-morbidities, including ischemic heart disease, chronic renal failure, chronic lung disease, and a history of prior cerebrovascular accident; 71 patients (60.6%) were smokers.