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A systematic review: impact of in-office biopsy on safety and waiting times in head and neck cancer

Published online by Cambridge University Press:  10 January 2022

A E Lim*
Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
A D G Rogers
Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
M Owusu-Ayim
Department of Otolaryngology, Ninewells Hospital, Dundee, Scotland, UK
S Ranjan
Department of Otolaryngology, Ninewells Hospital, Dundee, Scotland, UK
J Manickavasagam
Department of Otolaryngology, Ninewells Hospital, Dundee, Scotland, UK Tayside Academic Science Centre, University of Dundee, Scotland, UK
J Montgomery
Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
Author for correspondence: Dr A Lim, Department of Otolaryngology, Queen Elizabeth University Hospital, 1345 Govan Rd, GlasgowG51 4TF, UK E-mail:



This study aimed to assess the current literature on the safety and impact of in-office biopsy on cancer waiting times as well as review evidence regarding cost-efficacy and patient satisfaction.


A search of Cinahl, Cochrane Library, Embase, Medline, Prospero, PubMed and Web of Science was conducted for papers relevant to this study. Included articles were quality assessed and critically appraised.


Of 19 741 identified studies, 22 articles were included. Lower costs were consistently reported for in-office biopsy compared with operating room biopsy. Four complications requiring intervention were documented. In-office biopsy is highly tolerated, with a procedure abandonment rate of less than 1 per cent. When compared with operating room biopsy, it is associated with significantly reduced time-to-diagnosis and time-to-treatment initiation. It is linked to improved overall three-year survival.


In-office biopsy is a safe procedure that may help certain patients avoid general anaesthetic. It was shown to significantly reduce time-to-diagnosis and time-to-treatment initiation when compared with operating room biopsy. This may have important implications for oncological outcomes. In-office biopsy requires fewer resources and is likely to be cost-saving five-years following introduction. With high rates of sensitivity and specificity, in-office biopsy should be considered as the first-line procedure to achieve tissue diagnosis.

Main Article
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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