Techniques and Approaches for Safe, High-Yield CT-Guided Suprahyoid Head and Neck Biopsies

McKnight, Colin D.; Glastonbury, Christine M.; Ibrahim, Mohannad; Rivas-Rodriguez, Francisco; Srinivasan, Ashok

doi:10.2214/ajr.16.16558

Cited by 16 publications

(6 citation statements)

References 14 publications

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“…With regard to sensitivity, specificity, PPV and NPV of US‐PB in predicting malignancy, our data are in accordance with previous findings, 27–30 except for a low PPV; this is probably due to the fact that we considered the equivocal diagnoses (salivary gland neoplasm, basal cell neoplasm, oncocytic lesion) as potentially malignant and included under the malignant category. We think this is a reasonable approach because the surgeons in front of ambiguous diagnoses would treat the neoplasms with uncertain diagnosis as potentially malignant.…”

Section: Discussionsupporting

confidence: 92%

Diagnostic accuracy of ultrasonography‐guided core needle biopsy of parotid gland neoplasms: A large, single‐institution experience in United Kingdom

Walsh

Allan

Brennan

et al. 2021

J Oral Pathology Medicine

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The diagnosis of salivary gland neoplasms is a complex and difficult area of surgical pathology. Most of the salivary gland tumours present a varieted and pleomorphic morphology that make difficult the histopathological categorisation. In addition, there are no clinical and/or radiological features specific for each neoplasm. According to the latest WHO classification of the salivary gland tumours, there are more than 30 benign and malignant neoplastic entities, 1 15%-26% are malignant [2][3][4] and approximately 85% originate from the parotid gland. 5 Fine-needle aspiration (FNA) has been used for more than 50 years for the diagnosis of salivary gland tumours. 6 FNA is a safe, quick, less invasive, cost effective and relatively reliable diagnostic tool, especially when performed under the ultrasound guidance 7 and in experienced and skilful hands, 8 can be easily performed in the outpatient setting. In addition, it helps to plan the management and extent of parotid surgery. 8 However, FNA presents a high false positive rate, 9,10 and the data of its sensitivity, specificity and accuracy are controversial. FNA sensitivity presents a huge variability between 41.7% and 92.8%, and its specificity is 93.9%-98.5%. The overall diagnostic accuracy rates vary from 79% to 97%. 11,12 For malignant neoplasms, the FNA diagnosis is nondiagnostic in 26% of the cases. 11,13 In a series of 151 cases, FNA results were non-diagnostic/inconclusive in 18% of cases 14 and its sensitivity was 76%-92% for benign tumours and 53%-79% for malignant neoplasm. [15][16][17][18] FNA specimens are inadequate for diagnosis in 9%-12% of all cases and in 14% of malignant tumours. 18,19 It is worth mentioning that FNA is operator dependent technique and the results are strongly related to the experience of the clinicians and cytopathologists.

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Section: Discussionsupporting

confidence: 92%

Diagnostic accuracy of ultrasonography‐guided core needle biopsy of parotid gland neoplasms: A large, single‐institution experience in United Kingdom

Walsh

Allan

Brennan

et al. 2021

J Oral Pathology Medicine

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“…There are multiple described approaches to head and neck masses, with some overlap in the ability to access a deep neck space. [18][19][20][21] For example, pathways to reach the parapharyngeal, masticator, and pharyngeal spaces may include paramaxillary, retromandibular, submastoid, and subzygomatic approaches. Thus, it is important to fully evaluate the preprocedural imaging for the location of vessels, nerves, salivary glands, and salivary ducts to find the safest and most direct needle course.…”

Section: Discussionmentioning

confidence: 99%

“…There are multiple described approaches for biopsies in the head and neck, depending on the locations of the masses. [18][19][20][21] A brief description and the approximate needle course for the different biopsy approaches are presented in Fig 1 . Biopsy approaches for the patients in our group included the following: anterior 7/27, paramaxillary 2/ 27, posterior 5/27, retromandibular 2/ 27, submastoid 8/27, and subzygomatic/sigmoid notch 3/27 (Table 2). The anterior approach was used for lesions in the perivertebral, anterior cervical, prevertebral, visceral (Fig 2 ), and pharyngeal spaces.…”

Section: Biopsy Proceduresmentioning

confidence: 99%

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

Hillen

Baker²,

Long

et al. 2020

AJNR Am J Neuroradiol

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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 ...

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“…Followup imaging was reserved for patients who had experienced complications (such as local bleeding) during the procedure and for those who developed potentially procedurerelated symptoms during the observation period. The approaches employed were divided, according to the recommendations of previous studies (8,9) , into two categories (suprahyoid and infrahyoid), as detailed below.…”

Section: Methodsmentioning

confidence: 99%

Computed tomography-guided percutaneous biopsy of head and neck masses: techniques, outcomes, and complications

et al. 2021

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Objective: To assess the technique, efficacy, and safety of computed tomography (CT)-guided percutaneous biopsies of head and neck masses. Materials and Methods: This was a retrospective, single-center study of CT-guided percutaneous core-needle biopsies of head and neck masses. For the analysis of diagnostic accuracy, biopsy results were compared with the final diagnosis, which was determined by histological examination and clinical follow-up. Results: We evaluated 74 biopsies performed in 68 patients. The mean age of the patients was 55.6 years. Most of the lesions (79.7%) were located in the suprahyoid region, and the maximum diameter ranged from 11 mm to 128 mm. The most common approaches were paramaxillary (in 32.4%), retromandibular (in 21.6%), and periorbital (in 14.9%). Five patients (6.8%) developed minor complications. The presence of a complication did not show a statistically significant association with any clinical, radiological, or procedure-related factor. Sufficient material for histological analysis was obtained in all procedures. Thirty-eight biopsies (51.4%) yielded a histological diagnosis of malignancy. There was a false-negative result in three cases (8.3%), and there were no false-positive results. The procedure had a sensitivity of 92.7%, a specificity of 100%, and an accuracy of 96.0%. Conclusion: Our results demonstrate that CT-guided percutaneous core-needle biopsy of head and neck lesions is a safe, effective procedure for obtaining biological material for histological analysis.

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Techniques and Approaches for Safe, High-Yield CT-Guided Suprahyoid Head and Neck Biopsies

Cited by 16 publications

References 14 publications

Diagnostic accuracy of ultrasonography‐guided core needle biopsy of parotid gland neoplasms: A large, single‐institution experience in United Kingdom

Diagnostic accuracy of ultrasonography‐guided core needle biopsy of parotid gland neoplasms: A large, single‐institution experience in United Kingdom

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

Computed tomography-guided percutaneous biopsy of head and neck masses: techniques, outcomes, and complications

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