# Evaluation of a local anaesthetic biopsy service for suspected cancers at a tertiary head and neck unit: relevance to post-COVID-19 recovery of surgical services

## TL;DR

A local anaesthetic biopsy service for head and neck cancer was evaluated and found to be safe, efficient, and cost-effective, especially in post-pandemic recovery.

## Contribution

Demonstrates the effectiveness of local anaesthetic biopsies in reducing theatre use and improving diagnosis times in head and neck cancer.

## Key findings

- 72.8% of biopsied lesions were benign, while 25.7% were malignant.
- LA biopsy saved an estimated £900,000 over two years and avoided general anaesthesia risks.
- Transnasal endoscopy was a key method used and well tolerated by patients.

## Abstract

In response to pressures from the COVID-19 pandemic, a local anaesthetic (LA) biopsy service for patients with suspected head and neck cancer was set up at our centre.

This study was a prospective audit of patients referred for LA biopsy of head and neck lesions over a 2-year period at an adult United Kingdom tertiary head and neck centre.

In total, 202 patients had LA biopsy during the audit period. Most common types of biopsies were transoral (n = 65, 32.3%) and transnasal endoscopy and biopsy (n = 59, 29.2%). Some 72.8% (n = 147) of lesions were benign, whereas 25.7% (n = 52) of lesions were malignant. One specimen did not arrive at the laboratory and two specimens did not survive transportation/processing, necessitating repeat biopsies. Five patients required repeat biopsy following initial non-malignant histology result (2.47%), three of which required biopsy performed under general anaesthetic (1.49%). There were no identified post-procedure complications.

LA biopsy including transnasal oesophagoscopy/endoscopy is safe, well tolerated and can be used to assess patients with suspected head and neck cancer. Advantages include avoiding the risks of general anaesthesia and freeing up theatre capacity for more complex cases. We estimate savings of £900,000 over 2 years. Faced with limited theatre capacity and growing waiting lists, LA biopsy can also improve time to diagnosis and treatment for head and neck malignancies. We demonstrate the benefits of LA biopsy and highlight the role of transnasal oesophagoscopy/endoscopy in the recovery of surgical services in otolaryngology departments across the world in the post-pandemic era.