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Image Guided Head and Neck Biopsies: From Superficial to Deep
1Neuroradiology Division, Department of Radiology and Imaging Sciences, Associate Professor of Radiology, University of Utah, Salt Lake City, UT.
Techniques in Vascular and Interventional Radiology
|December 4, 2021
Summary
Image-guided biopsies aid in diagnosing head and neck cancers and infections when lesions are not palpable. This review covers biopsy techniques, imaging guidance, and safe targeting of deep head and neck lesions.
Area of Science:
- Radiology
- Head and Neck Surgery
- Oncology
- Infectious Diseases
Background:
- Image-guided biopsies are crucial for evaluating head and neck neoplasms and infections, especially for non-palpable or previously non-diagnostic lesions.
- These biopsies assist in surgical planning, preoperative treatment decisions (chemo-radiation), and non-operative management (e.g., lymphoma, HPV-related SCCa).
- For infections, biopsies help identify causative microorganisms for targeted antibiotic therapy.
Purpose of the Study:
- To review the fundamental aspects of image-guided head and neck biopsies.
- To discuss considerations for moderate intravenous sedation alongside local anesthesia.
- To compare fine-needle aspiration (FNA) and core needle biopsy (CNB) techniques and guide the choice between ultrasound (US) and computed tomography (CT) for imaging guidance.
Main Methods:
- Review of current practices and literature regarding image-guided head and neck biopsies.
- Discussion of pre-procedure evaluation and patient preparation.
- Case examples illustrating safe needle trajectories for CT-guided deep head and neck lesion targeting.
Main Results:
- Image guidance provides essential diagnostic information for head and neck neoplasms and infections.
- Selection between FNA and CNB depends on diagnostic yield and subsequent management.
- CT guidance offers precise targeting for deep-seated lesions, with specific trajectories discussed.
Conclusions:
- Image-guided biopsies are indispensable tools in head and neck diagnostics, influencing treatment strategies for both cancer and infection.
- Careful consideration of biopsy technique, sedation, and imaging modality (US vs. CT) optimizes diagnostic accuracy and patient safety.
- CT-guided approaches enable safe and effective biopsy of deep head and neck lesions.
