CT-Guided Needle Biopsy Provides Solution for Challenging Deep Neck Lesions

A recent study highlights the effectiveness of CT-guided core needle biopsy (CNB) as a diagnostic tool for lesions in the suprahyoid deep neck spaces where traditional ultrasound-guided biopsy proves inadequate. Conducted as a retrospective single-center cohort study, this research evaluated procedures performed between January 2005 and August 2024 at a specific center.

The investigation focused on patients with suspected neoplastic, inflammatory, or infectious head-and-neck lesions that were unsuitable for ultrasound guidance. Altogether, the study examined 122 biopsy procedures conducted on 118 patients. Vital data collected included age, sex, lesion characteristics, needle depth details, and post-procedural outcomes.

In cases where lesions were not adequately accessible or visualized via ultrasound, radiologists preferred CT-guided CNB. This approach involved using an 18-gauge core needle under sterile conditions with local anesthesia. Radiologists also performed immediate post-procedural CT imaging to detect early complications such as hemorrhage or injury to adjacent structures.

The CT-guided CNB procedures were predominantly located in the suprahyoid space, accounting for 94.3% of cases, with the remaining 5.7% performed in the infrahyoid neck. The study demonstrated a high diagnostic yield of 93.4%, with sensitivity and specificity rates of 86.2% and 100%, respectively. Among the biopsies, 73% were benign, with salivary gland tumors being the most common, while 20.5% were malignant, primarily metastatic tumors.

Additionally, exploratory analysis suggested that the diagnostic success was not significantly influenced by the size of the lesion. This finding supports the tool’s applicability over a range of lesion sizes in complex anatomical areas.

In clinical practice, the study concluded that CT-guided CNB serves as a complementary diagnostic method when ultrasound-guided techniques are not viable. Though surgical confirmation was available in only 31% of cases, other final diagnoses relied on clinical and imaging follow-up. However, 6.6% of the biopsies were inconclusive, indicating a need for further research to evaluate the generalizability and reliability of CT-guided CNBs in different clinical settings.

This study enriches the diagnostic armamentarium for interventional radiologists, particularly in cases where challenging head and neck anatomical barriers are present.