Korean J Radiol.  2013 Apr;14(2):299-306. 10.3348/kjr.2013.14.2.299.

CT-Guided Core Needle Biopsy of Deep Suprahyoid Head and Neck Lesions

• Wu EH
• Chen YL
• Wu YM
• Huang YT
• Wong HF
• Ng SH

• KMID: 1482791
• DOI: http://doi.org/10.3348/kjr.2013.14.2.299

Abstract

OBJECTIVE
To evaluate the efficacy of computer tomography (CT)-guided core needle biopsy (CNB) in the diagnosis of deep suprahyoid lesions in patients with treated head and neck cancers.
MATERIALS AND METHODS
Between December, 2003 and May, 2011, 28 CT-guided CNBs were performed in 28 patients with deep suprahyoid head and neck lesions. All patients had undergone treatment for head and neck cancers. Subzygomatic, paramaxillary, and retromandibular approaches were used. The surgical results, response to treatment, and clinical follow-up were used as the diagnostic reference standards.
RESULTS
All biopsies yielded adequate specimens for definitive histological diagnoses. A specimen from a right parapharyngeal lesion showed atypia, which was deemed a false negative diagnosis. Diagnostic accuracy was 27/28 (96.4%). Two minor complications were encountered: a local hematoma and transient facial palsy. Between the 18 or 20 gauge biopsy needles, there was no statistical difference in the diagnostic results.
CONCLUSION
CT-guided core needle biopsy, with infrequent and minor complications, is an accurate and efficient method for the histological diagnosis of deep suprahyoid lesions in post-treated head and neck cancer patients. This procedure can preclude an unnecessary surgical intervention, especially in patients with head and neck cancers.

Keyword

CT-guided needle biopsy; Head and neck; Neoplasms; Skull base; Core needle biopsy

MeSH Terms

Adult
Aged
Biopsy, Needle/*methods
Female
Head and Neck Neoplasms/*pathology/radiography
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Radiography, Interventional/*methods
Retrospective Studies
Tomography, X-Ray Computed/*methods

Figure

• 

  Fig. 1 Fifty one-year-old male (case 28) with left buccal cancer after surgery and radiotherapy. A. Contrast-enhanced CT scan shows large necrotic lesion in left masticator space with infiltrative part at periphery (arrow). B. Using subzygomatic approach, 17/18 G biopsy needle set is inserted into lesion (arrow). Biopsy revealed fibrosis with granulation. Follow-up image studies in three and six months showed lesion in stationary status, consistent with biopsy result (not shown).

• 

  Fig. 2 Sixty four-year-old male (case 27) with history of tongue cancer after operation and radiotherapy. A. Pre-procedural CT scan shows large infiltrative lesion in right parapharyngeal space (arrow). B. Using retromandibular approach, 17/18 G biopsy needle set is inserted in lesion (arrow). Biopsy revealed atypia. Progressive enlargement of lesion was noted in follow-up CT in one month (not shown). Patient died two months after procedure due to poor condition.

• 

  Fig. 3 Sixty four-year-old male (case 20) with buccal cancer after operation and radiotherapy. A. Contrast-enhanced CT shows infiltrative lesion in left parapharyngeal space (arrow). B. Using subzygomatic approach, 17/18 G biopsy needle set is inserted in lesion. Note hematoma in left messeter muscle (arrow). Biopsy revealed metastatic squamous cell carcinoma.

• 

  Fig. 4 Forty-year-old male (case 11) with left parotid adenoid cystic carcinoma after surgical excision. A. Contrast-enhanced CT shows heterogeneous hypodense lesion in deep lobe of left parotid gland (arrow). B. Using retromandibular approach, 17/18 G needle set is inserted in lesion (arrow). Biopsy revealed adenoid cystic carcinoma. Transient left facial palsy was noted immediately after procedure. Symptom subsided in 30 minutes.

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