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New guidance on pharyngolaryngeal biopsy under local anaesthesia

Patients across Wales could benefit from a new approach that could reduce the time taken to confirm a diagnosis of suspected cancer, while saving money for the NHS.

Health Technology Wales has completed its appraisal of “Pharyngolaryngeal biopsy under local anaesthesia for people with suspected head and neck cancer in the outpatient setting” and issued new guidance. The topic, proposed by Olympus, has been undergoing full appraisal since late 2021, following the publication of a Topic Exploration Report.

The Health Technology Wales guidance states: “The evidence supports the adoption of pharyngolaryngeal biopsy under local anaesthesia to confirm, but not to rule out, a diagnosis of head and neck cancer.

"This procedure can be performed in an outpatient setting and avoids the need for inpatient care and general anaesthesia. A positive result has the potential to accelerate the initiation of treatment, but a negative result should be followed by a second biopsy in an operating theatre under general anaesthesia.

"Economic modelling estimates that there is the potential for cost saving through the use of pharyngolaryngeal biopsy under local anaesthesia rather than in a theatre environment under general anaesthesia and that this is a cost-effective procedure.”

In Wales, there are around 500 new cases of head and neck cancers reported each year. Before the COVID-19 pandemic, around 800 patients each year underwent a pharyngolaryngeal biopsy procedure under general anaesthetic in an operating theatre across Wales.1 Many of these patients could now benefit from this new approach, which reduces their wait for a confirmed diagnosis and, where positive, can reduce their time to treatment commencing. Health Technology Wales found that the time between consultation and diagnosis could be reduced, on average, by more than two weeks (15.5 days).2

Overall, the panel concluded that outpatient biopsy under local anaesthetic should be recommended for routine adoption as a first step in the diagnostic pathway for head and neck cancer in appropriate and consenting patients, since it has the potential to reduce the time to diagnosis and treatment for some patients with cancer.

Speaking on the subject, Dr. Susan Myles, Director of Health Technology Wales, said: “Health Technology Wales produces national guidance on the use of non-medicine health technologies in Wales. Our aim is to drive improvements in population health and social care. We looked for evidence on the effectiveness of pharyngolaryngeal biopsies in the outpatient setting for people with suspected head and neck cancer after the topic was submitted to us by Olympus.

"The evidence showed that pharyngolaryngeal biopsies can be done under local anaesthetic without needing to wait for a surgery slot, which could lead to a quicker diagnosis of cancer, and could allow for quicker treatment. Our guidance concludes that the evidence supports the adoption of pharyngolaryngeal biopsy under local anaesthesia to confirm, but not to rule out, a diagnosis of head and neck cancer.”

Early detection and diagnosis, alongside timely intervention, is essential for improving outcomes for suspected cancer patients. The NHS in Wales has faced a challenge with timely intervention in recent times for patients on the suspected cancer pathway. The publication of this guidance can provide Local Health Boards with an opportunity to reduce the time between suspicion and first treatment by aiding in a quicker diagnosis.

Alex Zervakis, General Manager, Health Economics & Market Access, Olympus UK & Ireland, also added: “We are delighted with the outcome of this appraisal. It’s fantastic to see how technology has the potential to enable more timely care for patients and help drive down costs for the NHS. We hope to see strong adoption of this new approach across Wales, enabling many patients to benefit from a faster diagnosis and quicker access to treatment.”

Health Technology Wales (HTW) research and evaluate the best available clinical and cost-effectiveness evidence about a health technology. More information about their Health Technology Appraisal (HTA) process can be found at: www.healthtechnology.wales/about/our-appraisal-process/

To read the full guidance and evidence appraisal on Laryngeal biopsies in the Outpatient setting in people with suspected head and neck dysplasia/cancer, published by Health Technology Wales, please head to: https://healthtechnology.wales/reports-guidance/outpatient-laryngeal-biopsy/

References:

  1. (Sum of Finished Consultant Episodes for Principal Procedure Codes: E251, E252, E361, E367), NHS Wales Informatics Service, PEDW Statistics - 2017/18, 2018/19 and 2019/20 https://dhcw.nhs.wales/information-services/health-intelligence/annual-pedw-data-tables/
  2. Health Technology Wales Evidence Appraisal Report - From consultation to diagnosis under pharyngolaryngeal biopsies with local anaesthetic (OLB), the mean number of days was 7.5, compared to 23 when undergoing biopsy in an operating theatre (OTB) under general anaesthetic. https://healthtechnology.wales/wp-content/uploads/2022/07/EAR040-OLB-FINAL.pdf

 

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Upcoming Events

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Access the latest issue of Clinical Services Journal on your mobile device together with an archive of back issues.

Download the FREE Clinical Services Journal app from your device's App store

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