Percutaneous CT-Guided Core Needle Biopsies of Head and Neck Masses: Technique, Histopathologic Yield, and Safety at a Single Academic Institution

Abstract

BACKGROUND AND PURPOSE: CT-guided head and neck biopsies can be challenging due to the anatomy and adjacent critical structures but can often obviate the need for open biopsy. A few studies and review articles have described approaches to biopsy in the head and neck. This retrospective study evaluated technical considerations, histopathologic yield, and safety in CT-guided head and neck core needle biopsies. MATERIALS AND METHODS:A retrospective review of head and neck biopsies performed from January 2013 through December 2019 was conducted. Clinical diagnosis and indication, patient demographics, mass location and size, biopsy needle type, technical approach, dose-length product, sedation details, complications, diagnostic histopathologic yield, and the use of iodinated contrast were recorded for each case.RESULTS: A total of 27 CT-guided head and neck core needle biopsies were performed in 26 patients. The diagnostic sample rate was 100% (27/27). A concordant histopathologic diagnosis was obtained in 93% (25/27) of cases. There was a single complication of core needle biopsy, a small asymptomatic superficial hematoma.CONCLUSIONS: Percutaneous CT-guided biopsy of deep masses in the head and neck is safe and effective with careful biopsy planning and has a high diagnostic yield that can obviate the need for open biopsy.ABBREVIATION: CTCAE ¼ Common Terminology Criteria for Adverse Events I n the United States, .60,000 new cases of head and neck cancer will be diagnosed in 2020, comprising approximately 4% of new cancer cases in men. 1 Many of these cancers that arise within the oropharynx are diagnosed by an otolaryngologist using direct visualization by laryngoscopy. Most of the superficial soft-tissue masses in the neck are biopsied either by palpation 2 or sonographic guidance. [3][4][5][6] The masses within the deep spaces of the neck are most commonly biopsied using CT guidance. In the past, many of these deep head and neck biopsies were performed using CT guidance and fine-needle aspiration techniques. 7-10 More recent articles have described the use of CT guidance and spring-loaded core biopsy needles. [11][12][13][14][15] Compared with other biopsies, deep head and neck masses are difficult to biopsy safely and effectively due to the critical anatomy in the region of the biopsies, including nerves, vessels, and salivary glands. Despite the critical anatomy, there are few reported serious complications in head and neck soft-tissue biopsies. 16 In general, the demand for percutaneous CT-guided biopsies continues to increase due to the evolving requirements of clinical treatment and study protocols. The well-published safety, efficacy, and high histopathologic yield obviates the need for open biopsies; however, there are relatively few publications addressing CT-guided soft-tissue core biopsies of the head and neck.The purposes of this retrospective original research are to describe and expand technical considerations, including the use of CT angiography, and to demonstrate the high histopathologic yield and ...

Ultrasound Fusion–Guided Core Needle Biopsy for Deep Head and Neck Space Lesions: Technical Feasibility, Histopathologic Yield, and Safety

“…The minor complication rate was 12.5% (2/16), including mild inflammation of the puncture site and self-limited blood-tinged sputum. Mild infection and bleeding were the most reported minor complications after image-guided biopsy in the H&N. [3][4][5][6][7][8][9][10][11] Other minor complications included vasovagal reaction, transient facial palsy, and CSF leakage, which did not occur in this study.…”

“…Previous studies have shown a diagnostic rate of CT-guided core needle biopsy of 73%-96.8% in lesions involving the H&N as a whole. [4][5][6][7] The average size of all target lesions was approximately 2.4-3.3 cm, 4-6 including superficial and lower cervical masses. For emerging infrared navigation-guided biopsy, the diagnostic rate was approximately 90%.…”

“…CT guidance is a well-established biopsy method for H&N lesions, 3,4 but reports involving deep H&N spaces are few and mostly limited to small samples of patients. [5][6][7] In addition, infrared navigation-guided biopsy has been explored in a small number of patients at a few institutes. [8][9][10] MR imaging guidance is not widely used because of the longer acquisition times, higher cost, and the need for an open-configuration MR imaging system and MR imaging-compatible needles.…”

“…3,11 Ultrasound (US) guidance, with its inherent advantages of realtime imaging capability, rapid performance time, vessel depiction without intravenous contrast material, flexibility and portability, lack of radiation exposure, and high cost-effectiveness, is generally the first-line choice for biopsies on many H&N masses. However, to date, almost all researchers consider US unsuitable for the deep H&N region, 3,[5][6][7][8][9]12 for 2 reasons: First, acoustic degradation increases with depth, especially when the depth is .4 cm, 12 increasing the difficulty in delineating a target reliably; and second, osseous or air structures preclude an adequate acoustic window for US scanning.…”

Percutaneous CT-Guided Core Needle Biopsies of Head and Neck Masses: Review of 184 Cases at a Single Academic Institution, Common and Special Techniques, Diagnostic Yield, and Safety

“…6 Several standard approaches to H&N CT-guided CNB are used, including subzygomatic, paramaxillary, retromandibular, anterior, lateral, and posterior approaches. [7][8][9][10][11][12][13] These are illustrated in Fig 1 . A recently published review of 27 CT-guided CNBs by Hillen et al 14 demonstrated the effectiveness and safety of these procedures for H&N lesions. However, large studies evaluating the diagnostic yield and safety profile of CT-guided H&N CNBs with a variety of locations and lesion sizes are lacking.…”