The question is whether or not TFL with biopsy gives accurate final pathological results. According to our statistical analysis, the specificity of TFL in diagnosing invasive carcinoma is excellent, but the sensitivity of diagnosing a suspicious lesion as being CIS or invasive carcinoma is only 70.6%. The only other study asking the Inhibitors,research,lifescience,medical same question showed 64% diagnostic results in a small group of 11 patients with suspicious laryngeal lesions.12 Although in this Boston University study the biopsies were taken using distal chip camera video endoscope, which is superior to our study’s conventional fiberoptic endoscope, our diagnostic results were similar,

if not even better (68.6%). Nearly all other studies on in-office Inhibitors,research,lifescience,medical endoscopic biopsies had selleck chemicals focused on suspected

lesions of the upper aerodigestive tract, and mainly on the esophagus and hypopharynx. Postma et al.14 reported 100% accuracy of transnasal esophagoscopy in 17 patients with known lesions of the upper aerodigestive tract. Esophageal biopsies obtained by means of transnasal esophagoscopy are easier to achieve than those from the larynx due to gag and cough reflexes. Thus, Inhibitors,research,lifescience,medical improper sample sizes and imprecise biopsies may bias results. Price et al.15 reviewed 18 patients who underwent transnasal flexible laryngo-esophagoscopy for 12 cases of laryngeal lesions. Those authors expressed concern that the size of the acquired biopsy might result

in an underestimation of the depth of invasion. Inhibitors,research,lifescience,medical Wang et al.16 evaluated the efficacy of non-sedated transnasal esophago-gastro-duodenoscopy in the diagnosis of esophageal lesions and reported an 11.1% rate of inaccurate pathological diagnosis among 27 patients with hypopharyngeal Inhibitors,research,lifescience,medical cancer. Noteworthily, the conclusions of all the above-mentioned studies were drawn from results derived from much smaller cohorts than the one reported herein and were not compared with biopsies taken under direct laryngoscopy. It is our impression that pathologists are reluctant to conclude that cancer is present in laryngeal biopsies from small samples. A study by Sarioglu et al.17 in which laryngeal pre-neoplastic lesions were evaluated by 14 different pathologists using the World Health Organization, Ljubljana, and squamous intraepithelial neoplasia classification systems concluded Phosphatidylinositol diacylglycerol-lyase that there was a significant difference between the participants in all three classification systems, and the authors questioned intra-observer accuracy. There is a lack of willingness on the part of the pathologists to commit to a final pathologic diagnosis of CIS/invasive carcinoma based on small fragments of tissue obtained via TFL. We used fiberoptic equipment in order to achieve the laryngeal view in our current work.