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ORIGINAL ARTICLE
Year : 2012  |  Volume : 2  |  Issue : 2  |  Page : 85-88

Trucut biopsy - An effective diagnostic tool in laryngeal and hypopharyngeal cancers: A preliminary study


1 Department of ENT, Deenanath Mangeshkar Hospital, Erandwane, Pune, Maharashtra, India
2 Department of Surgery, Deenanath Mangeshkar Hospital, Erandwane, Pune, Maharashtra, India
3 Department of Pathology, Deenanath Mangeshkar Hospital, Erandwane, Pune, Maharashtra, India

Date of Web Publication5-Feb-2013

Correspondence Address:
Nilanjan P Bhowmick
Department of ENT, Deenanath Mangeshkar Hospital, Erandwane, Pune - 411 004, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2230-9748.106985

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   Abstract 

Background: Laryngeal and hypopharyngeal cancers are commonly diagnosed by histopathological examination of a punch biopsy specimen from the lesion. The histopathological report of the punch biopsy specimen in certain cases is inconclusive, most commonly in cases of endophytic growths. Objective: To evaluate the efficacy of trucut biopsy as a diagnostic procedure in such cases of laryngeal and hypopharyngeal growth which are clinically malignant but histopathology report by punch biopsy is inconclusive. Materials and Methods: Seven cases with clinical suspicion of laryngeal or hypopharyngeal malignancies but with inconclusive histopathological examination on punch biopsy were included. Trucut biopsy was performed in them. 6 out of the 7 trucut biopsies were found to be malignancies on histopathological examination. Conclusion: Trucut biopsy is promising diagnostic tool in laryngeal and hypopharyngeal malignancies especially in those cases where there is strong suspicion of malignancy and the punch biopsy does is inconclusive.

Keywords: Biopsy, hypopharynx, larynx, malignancy, trucut


How to cite this article:
Gandhi S, Bhowmick NP, Kelkar DS, Chandorkar A. Trucut biopsy - An effective diagnostic tool in laryngeal and hypopharyngeal cancers: A preliminary study. J Laryngol Voice 2012;2:85-8

How to cite this URL:
Gandhi S, Bhowmick NP, Kelkar DS, Chandorkar A. Trucut biopsy - An effective diagnostic tool in laryngeal and hypopharyngeal cancers: A preliminary study. J Laryngol Voice [serial online] 2012 [cited 2021 Aug 1];2:85-8. Available from: https://www.laryngologyandvoice.org/text.asp?2012/2/2/85/106985


   Introduction Top


Laryngeal cancer comprises around 1.7% of all malignant diseases diagnosed annually worldwide. [1] Hypopharyngeal malignancies are around 4 times less common than laryngeal malignancies. [2] The mainstay of diagnosis is based on endoscopic visualization, radiological imaging and histopathological examination of biopsy specimen. The most common method of obtaining a biopsy from the lesion is by laryngoscopic examination and taking an adequate sized biopsy under direct vision using a punch forceps. However, in practice is experienced that quite a few times the punch biopsy taken from the tumor mass proves non confirmatory. Multiple biopsies may be required to confirm the clinical suspicion of laryngeal carcinoma. [3] Due to this non representative biopsy there is a delay in the commencement of treatment and in some cases may lead to change in the staging of the disease. [3] It is noted that non representative punch biopsy is common in cases of endophytic malignancies or in cases of invasive carcinoma with overlying inflammation or oedema. These cases require biopsy from the tissue underlying the smooth mucosa. We have undertaken biopsy using a trucut needle in cases with clinical suspicion of laryngeal and hypopharyngeal malignancy but with no evidence of malignancy on histopathological examination of punch biopsy specimen. We undertook this preliminary study to know the effectiveness of trucut biopsy as a diagnostic tool.


   Materials and Methods Top


This was a prospective study over 3 months. Patients with strong clinical suspicion of malignancy but with negative report on biopsy were included in the study. These patients underwent flexible laryngoscopy and CT scans. Those patients in whom radiology and laryngoscopy gave a strong clinical suspicion of malignancy formed part of study group and were subjected to trucut biopsy [Figure 1], [Figure 2], [Figure 3] and [Figure 4]. A total of 7 patients formed the study group. The mean time duration elapsed between the first biopsy and the subsequent trucut biopsy was fifteen days [Table 1] and [Table 2].
Figure 1: Bulky right true and false cords on CT scan

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Figure 2: Left glottic growth with anterior commissural involvement

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Figure 3: Right false cord suspected lesion

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Figure 4: Bilateral immobile vocal cords with right false cord and aryepiglottic fold swelling

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Table 1: Patients undergoing trucut biopsy, laryngoscopy and CT findings and site of trucut biopsy


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Table 2: Results of histopathological examination of biopsy specimens of trucut and punch biopsy

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Trucut biopsy: These patients were subjected to Microlaryngoscopic examination under general anaesthesia. Trucut biopsy from the lesion was undertaken under microlaryngoscopic visualization in 5 of the 7 patients. In 2 of the cases in whom microlarygoscopic visualization of tumor was not feasible, a CT-guided trucut biopsy was done. The trucut biopsy needle with a penetration depth of 22 mm and gauge 18 G was used [Figure 5] and [Figure 6]. The needle with a gap near its tip was passed into the lesion. Then a surrounding sheath with a cutting tip was passed down the needle. The sheath cut the specimen corresponding to the space in the needle.
Figure 5: Trucut Biopsy needle

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Figure 6: Bevelled end of the trucut Biopsy needle

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The needle and sheath, with the specimen, were then removed from the lesion and the specimen thus collected was sent for histopathological examination. It was ensured that the same pathologist examined the specimen who had examined the initial punch biopsy specimen.


   Results Top


Seven patients formed the study group. Histopathological examination of trucut biopsy of 6 of the 7 patients (85.71%) showed malignancy. In one patient (14.28%) the report was angiomatous lesion. The time duration required to achieve haemostasis after the trucut biopsy was less than 1 minute in all but 1 case which was the angiomatos lesion.


   Discussion Top


Use of trucut biopsy from laryngeal and hypopharyngeal malignancy is a new concept and literature search did not show any such study. There are studies comparing trucut biopy with punch biopsy for pathology in pleura. [4]

Endolaryngeal and hyopopharyngeal lesions are most commonly biopsied by microlaryngoscopic examination under general anaesthesia. [5] The procedure is generally a punch biopsy. In certain cases the biopsy material proves to be inconclusive. The possible explanation to this could be that punch biopsies may not include the malignancy, more so in endophytic growths or in cases of invasive carcinoma with overlying oedema or inflammation. [6] The pathologist can make an accurate histological diagnosis based on the architecture and type of cells. There should be sufficient tissue in the biopsy and from proper depth.

The trucut biopsy included tissue from a depth of 22 mm. Trucut biopsies are useful when the biopsy sample has to include cells from the tissue underlying the inflammation, oedema or in cases of endophytic growths.

In all 7 cases there had been previous punch biopsy failure following which trucut biopsy was done. It was found that trucut biopsy was a technically simple procedure. In 2 of the 7 patients microlaryngoscopic visualization of the tumor was not possible and hence a CT guided trucut biopsy from the tumor under local anaesthesia was done. Both the patients withstood the procedure well without any adverse effects in all of the above cases we found that trucut biopsy is faster and causes lesser bleeding than punch biopsy. Being a simple and complication-free method makes trucut biopsy technique preferable, especially in cases with endophytic malignancies. The advantage of trucut biopsy is the depth from which the tissue is collected but the possible disadvantage is insufficient material being collected. [7]


   Conclusion Top


Trucut biopsy is a promising diagnostic tool in laryngeal and hypopharyngeal malignancies especially in those cases where there is strong suspicion of malignancy and the punch biopsy is inconclusive.

 
   References Top

1.Wünsch Filho V. The epidemiology of laryngeal cancer in Brazil. Sao Paulo Med J 2004;122:188-94.  Back to cited text no. 1
    
2.Hermans R. Staging of laryngeal and hypopharyngeal cancer: Value of imaging studies. Eur Radiol 2006;16:2386-400.  Back to cited text no. 2
    
3.Welge-Lüssen A, Glanz H, Arens C, Oberholzer P, Probst R. Multiple biopsy in diagnosis of laryngeal carcinoma. Laryngorhinootologie 1996;75:611-5.  Back to cited text no. 3
    
4.Mcleod DT, Ternouth I, Nkanza N. Comparison of the tru-cut biopsy needle with the Abrams punch for pleural biopsy. Thorax 1989;44:794-6.  Back to cited text no. 4
    
5.Preda L, De Fiori E, Rampinelli C, Ansarin M, Petralia G, Maffini F, et al. US-guided transcutaneous tru-cut biopsy of laryngo-hypopharyngeal lesions. Eur Radiol 2010;20:1450-5.  Back to cited text no. 5
    
6.Michaels L, Henrik B. Hellquist. Ear, Nose and Throat Histopathology. p. 384-6.  Back to cited text no. 6
    
7.Ayhan NK, Keskun C, Olgac V, Dedeoglu K, Yaltiri M, Erseven G, et al. Trucut and fine needle aspiration biopsy diagnosis of lesions of the jaws. Turk J Med Sci 2003;33:249-53.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1], [Table 2]



 

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