Computed Tomography–Guided Needle Biopsy of Head and Neck Lesions

DelGaudio, John M.; Dillard, David G.; Albritton, Ford D.; Hudgins, Patricia A.; Wallace, Virginia C.; Lewis, Melinda M.

doi:10.1001/archotol.126.3.366

Cited by 45 publications

(20 citation statements)

References 10 publications

(18 reference statements)

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“…In a study on 216 CTguided FNAB for head and neck bulks, 27 of them involving the PPS, a correct diagnosis was made in 88.4% of cases, an incorrect diagnosis in only 1.9% of samples and nondiagnostic samples made up the remaining 9.7%. These results are certainly important, but they were obtained with the presence of a cytopathologist during FNA to achieve high diagnostic rates and, as suggested elsewhere in the literature [19], after a learning curve that gave neuroradiologists more experience [20]. In a study on 29 patients with PPS tumors, Farrag et al [21] reported a CT-guided FNAB Positive Predictive Value (PPV) of 90% for detection of benign lesions, while for malignancies, PPV was 75%.…”

Section: Discussionmentioning

confidence: 99%

Parapharyngeal space tumors without mandibulotomy: our experience

Presutti

Molteni

Malvè

et al. 2011

Eur Arch Otorhinolaryngol

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Parapharyngeal space (PPS) tumors are rare and benign in 80% of cases. Since surgeons first resected this anatomical region, the surgical approach to PPS bulks has been a hot topic due to their shape and the important structures involved. We present a series of patients treated with a transcervical or transcervical-transparotid approach to benign PPS tumors without mandibulotomy. Between May 2003 and March 2009, 18 patients (11 male and 7 female) with benign PPS tumors underwent a surgical resection, avoiding mandibulotomy. Average age of the patients was 49 years (range 3-76), average tumor size was 5.5 × 4 × 3 cm and histological examination of the resected tumors showed: seven pleomorphic adenomas of the deep parotid lobe, four schwannomas, two mycobacteriosis, two paragangliomas of the vagus nerve, one lipoma, one neurofibroma and one cavernous hemangioma. Seven patients underwent a transcervical approach, while 11 patients underwent a transcervical-transparotid approach. Excision of benign PPS tumors is possible without mandibulotomy even in the case of a large tumor mass, but exposure with the mandible in situ is certainly poor. Avoiding mandibulotomy reduces patient morbidity and hospital stay. In our experience, mandibulotomy can be avoided in most cases of benign PPS tumors leaving this procedure for malignant tumors or in patients with very poor exposure

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Section: Discussionmentioning

confidence: 99%

Parapharyngeal space tumors without mandibulotomy: our experience

Presutti

Molteni

Malvè

et al. 2011

Eur Arch Otorhinolaryngol

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“…Percutaneous needle biopsy with imaging guidance is a well-established technique for diagnosis of head and neck lesions (1)(2)(3)(4)(5)(6)(7)(8). Computed tomography (CT)-guided biopsies of deep-seated head and neck lesions are challenging because major vessels, nerves, the airway, or osseous structures often intervene in the projected needle path.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous Biopsy of Head and Neck Lesions with CT Guidance: Various Approaches and Relevant Anatomic and Technical Considerations

Gupta¹,

Henningsen²,

Wallace³

et al. 2007

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Deep-seated head and neck lesions, which traditionally were evaluated by surgical means, are now accessible with less invasive computed tomography-guided percutaneous needle biopsy techniques. Major vessels, the trachea, and osseous structures like the maxilla, mandible, and vertebrae often preclude direct access to these lesions. It is important to understand the anatomy relevant to safe access route planning and the techniques, advantages, and limitations associated with various approaches used for percutaneous biopsy of head and neck lesions. For biopsy of suprahyoid head and neck lesions, including those of the skull base and upper cervical vertebrae, various approaches such as the subzygomatic, retromandibular, paramaxillary, submastoid, transoral, and posterior approaches can be used. Lesions in the infrahyoid portion of the neck and lower cervical vertebrae can be accessed with the anterolateral approach (between the airways and the carotid sheath), posterolateral approach (posterior to the carotid sheath), and direct posterior approach. The location and extent of the lesions and their relationship to adjacent structures influence the choice of the trajectory to use. Careful planning of the procedure and considerable familiarity with head and neck anatomy are necessary for a biopsy that is both precise and safe.

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“…However, image degradation related to the air-containing aerodigestive tract and adjacent bones can be limiting. CT-guided needle biopsy of head and neck lesions has been reported to be safe and effective [5]. However, the limited contrast resolution of soft tissues, exposure to ionizing radiation, and potential requirement of iodine contrast enhancement for lesion delineation can be limitations of CT guidance.…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) have been used successfully for image-guided head and neck biopsies [4][5][6][7]. However, depending on the imaging technique used, different efficacies and limitations apply.…”

Section: Introductionmentioning

confidence: 99%