Topical Tranexamic Acid Application to Facilitate Biopsy Acquisition in Endoscopic Nasopharyngeal Biopsy: A Prospective Case Series Analysis.

Background

Nasopharyngeal carcinoma diagnosis requires endoscopic biopsy, but intraoperative hemorrhage frequently impairs visualization and compromises tissue sampling quality. This prospective case series evaluated topical tranexamic acid (TXA) as a hemostatic adjunct to improve biopsy conditions in suspected nasopharyngeal malignancy.

Methods

Adults (≥18 years) with clinically/radiologically suspected nasopharyngeal tumors underwent pre-biopsy laboratory screening and exclusion of thromboembolic risk factors. After topical lidocaine anesthesia, a TXA-soaked cotton pledget was applied to the lesion for 10 min prior to forceps biopsy using 0° 4 mm endoscopy. Bleeding severity was graded pragmatically (minimal: ≤3 gauze pledgets; moderate: >3 or cauterization). Comparative analyses excluded rare diagnoses (n = 1).

Results

Of 40 enrolled patients, 34 underwent biopsy (mean age 58.4 ± 12.3 years). All 34 biopsies (100%) yielded conclusive histopathological diagnoses. Adequate hemostasis was achieved in 97.1% (33/34), with minimal bleeding in 76.5% and moderate/massive in 23.5%. Non-keratinizing squamous cell carcinoma (44.1%) showed higher moderate bleeding rates than other diagnoses (Fisher's exact p = 0.00035). Mean hospitalization was 1.79 ± 1.92 days, uniform across categories. No TXA-related adverse events occurred.

Conclusions

Topical TXA provided safe, effective hemostasis during nasopharyngeal biopsy across diverse pathologies, achieving 100% diagnostic adequacy and short hospital stays. Controlled trials comparing TXA versus standard hemostatic techniques are warranted.