Pitfalls in image guided tissue sampling in the head and neck

Image-guided tissue sampling is becoming increasingly important for management of head and neck cancers. Ultrasound-guided fine-needle aspiration (UG-FNA) is safe, effective, and has many advantages compared with palpation-guided FNA and computed tomography-guided FNA. The technique of UG-FNA is highly operator and experience dependent; however, understanding the complex anatomy, disease processes, and patterns of nodal spread in the head and neck make this technique ideal for the neuroradiologist. Proper technique and recognition of pitfalls are critical to successful UG-FNA. Computed tomography-guided FNA is valuable for tissue sampling from deep lesions and for those without a sonographic window for UG-FNA.