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 diagnosis. 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 carcinoma 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 the diagnosis was analysed and the follow-up of the patients was evaluated. Thirty of 32 negative histologic samples were reexamined. Results: Of 468 patients, 32 (7%, 27 [B] 14%; and 5 [G] 2%) required two to six biopsies to confirm the clinically suspected diagnosis: Twenty patients (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 patients (Group 3) more than 24 months after the first biopsy. Final treatment and outcome in patients from Group 1 was unchanged by the time delay in diagnosing the tumor. Seven of eight patients in Group 2 experienced an obvious progression of their tumor during the diagnostic period, which led to laryngectomy in several cases. In four patients, diagnosis was confirmed more than two years after the first biopsy. These were special cases such as development of cancer out of a papillomatosis or chronic laryngitis. Conclusions: A time delay of three months in diagnosing cancer of the larynx does not have a significant influence on organ preservation and prognosis, even though especially in small tumors suspicion of cancer should lead to a new representative biopsy as fast as possible to preserve the larynx.