How a biopsy be taken ideally from nasopharynx?

  • Biopsy of the nasopharynx is considered the first necessary investigation for Nasopharyngeal carcinoma (NPC) if a suspicious lesion is formed.
  • Ideally this should be carried out during the patients first out patient visit.
  • The biopsy procedure is carried out under the topical anesthesia with the patient seated.
  • A diagnostic nasoendoscopy should be carried out first nothing the site of the tumour if present.
  • The flexible nasopharyngoscope is first introduced through the nose contralateral to the side of the suspected nasopharyngeal tumours. Its tip is directed towards tumour or the endoscope is passed through the side of the nose where the tumour is less bulky, leaving the ipsilateral side clean for the passage of the biopsy forceps.
  • The biopsy should be taken under direct vision using cutting biospy forceps c large cups.
  • The takayasu biopsy forceps or Hildyard or 45º hencked forceps (for deep biopsy and biopsy of fossa of rosenmuller) is then inserted along the nasal floor on the side of the tumour into the nasopharynx. The position of the biopsy forceps should be checked by the scope and biopsy is taken. The pulling of tissue should be avoided and one byte on the tumours is usually adequate for diagnosis with cutting forceps. There will be some bleeding but post biopsy epistaxsis is rare.
  • Biopsy can also be taken through the channel inflexible endoscope but are usually not recommended as a tiny forceps provides an adequate tissue sample for diagnosis.
  • Rigid 0° and 30° sinus endoscope can similarly be used in clinical settings. Generally their manipulation in the nose causes more discomfort to the patient. They are however the scope of choice in examination and biopsy.
  • In cases where clinical suspicious exists but the nasopharynx appears normal when when previous biopsy specimens taken under topical anesthesia are in conclusion an examination and biopsy taken with the patient under GA is mandatory. Multiple deep biopsies should be taken from the central nasopharynx and both fossae of Rosenmuller.
  • The Yankauer nasopharyngeal speculum is a very useful and to open up and give access to the depths of the fossa of Rosenmuller.
  • If special histo-chemical staining  is anticipated, The biopsy specimens should be sent fresh to pathologists.
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