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Betting T, Benson JC, Madhavan A, Shlapak D, Morris P, Morris J, Diehn F, Verdoorn J, Liebo G, Carr C. Safety and histopathologic yield of percutaneous CT-guided biopsies of the skull base, orbit, and calvarium. Neuroradiology 2024; 66:417-425. [PMID: 38197949 DOI: 10.1007/s00234-023-03266-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 12/06/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE Although CT-guided biopsies of the calvarium, skull base, and orbit are commonly performed, the best approaches, efficacy, and safety of such procedures remain scantly described in the literature. This retrospective review of percutaneous biopsies illustrates several approaches to challenging biopsy targets and provides a review of procedural planning considerations and histopathologic yield. METHODS A retrospective review of CT-guided biopsies of the skull base, calvarium, and orbit between 1/1/2010 and 10/30/2020 was conducted. Patient demographics and procedural factors were recorded, including lesion size and location, biopsy approach, and needle gauge. Outcomes were also noted, including CT dose length product, complications, and histopathologic yield. RESULTS Sixty-one CT-guided biopsies were included in the final analysis: 34 skull base, 23 calvarial, and 4 orbital lesions. The initial diagnostic yield was 32/34 (94%) for skull base lesions, with one false-negative and one non-diagnostic sample. Twenty-one of twenty-three (91%) biopsies in the calvarium were initially diagnostic, with one false-negative and one non-diagnostic sample. In the orbit, 4/4 biopsies were diagnostic. The total complication rate for the cohort was 4/61 (6.6%). Three complications were reported in skull base procedures (2 immediate and 1 delayed). A single complication was reported in a calvarial biopsy, and no complications were reported in orbital biopsies. CONCLUSION Percutaneous CT-guided core needle biopsies can be performed safely and with a high diagnostic yield for lesions in the skull base, calvarium, and orbit.
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Affiliation(s)
- Theodore Betting
- Mayo Clinic, Rochester, 200 1st St. SW, Rochester, MN, 55905, USA.
| | - John C Benson
- Mayo Clinic, Rochester, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Ajay Madhavan
- Mayo Clinic, Rochester, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Darya Shlapak
- Mayo Clinic, Rochester, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Padraig Morris
- Mayo Clinic, Rochester, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Jonathan Morris
- Mayo Clinic, Rochester, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Felix Diehn
- Mayo Clinic, Rochester, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Jared Verdoorn
- Mayo Clinic, Rochester, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Greta Liebo
- Mayo Clinic, Rochester, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Carrie Carr
- Mayo Clinic, Rochester, 200 1st St. SW, Rochester, MN, 55905, USA
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Jalaly JB, Baloch ZW. Salivary gland neoplasms in small biopsies and fine needle aspirations. Semin Diagn Pathol 2023; 40:340-348. [PMID: 37085434 DOI: 10.1053/j.semdp.2023.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/31/2023] [Accepted: 04/13/2023] [Indexed: 04/23/2023]
Abstract
Salivary gland neoplasms are rare and represent a diverse group of head and neck tumors. Their diagnosis in limited cellularity specimens can be challenging as many of these have overlapping clinical, radiological presentation, and pathologic features. Fine needle aspiration and/or core biopsies are more of a norm than rarity to be performed preoperatively to provide invaluable information that can guide clinical management including surgery. Even though these limited specimens may not always provide a definitive diagnosis; they have high sensitivity in confirming primary neoplasia, assessing the tumor grade, and ruling out non-surgical disease. An algorithmic pattern based approach can help narrow the differential diagnosis; leading to a definitive diagnosis with the help of specific ancillary studies.
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Affiliation(s)
- Jalal B Jalaly
- Perelman School of Medicine Department of Pathology, Hospital of the University of Pennsylvania, 6 Founders, 3400 Spruce Street, Philadelphia, PA 19103 United States.
| | - Zubair W Baloch
- Perelman School of Medicine Department of Pathology, Hospital of the University of Pennsylvania, 6 Founders, 3400 Spruce Street, Philadelphia, PA 19103 United States
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3
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Agarwal A, Murray J, Sandhu SJ. Image-Guided Biopsies of Superficial and Deep Head and Neck and Skull-Base Lesions. Oral Maxillofac Surg Clin North Am 2023:S1042-3699(23)00008-0. [PMID: 37032175 DOI: 10.1016/j.coms.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Percutaneous image-guided biopsy has largely replaced open surgical biopsies for many head and neck (H&N) lesions, being very safe and minimally invasive. Although the radiologist plays the primary role in these cases, it requires a multidisciplinary approach. Depending upon numerous factors, these biopsies can be either fine-needle aspiration or core needle biopsy, using ultrasound for superficial lesions and computed tomography for deep neck lesions. The most crucial part of H&N biopsies is planning a trajectory to avoid injury to critical anatomic structures. This article outlines the standard biopsy approaches and key anatomical considerations for H&N procedures.
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Affiliation(s)
- Amit Agarwal
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
| | - John Murray
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - S Johnny Sandhu
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
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Haller TJ, Van Abel KM, Yin LX, Lohse CM, Douse D, Badaoui JN, Price DL, Kasperbauer JL, Moore EJ. Ultrasound Guided Biopsy in Patients With HPV-Associated Oropharyngeal Squamous Cell Carcinoma. Laryngoscope 2022; 132:2396-2402. [PMID: 35275423 DOI: 10.1002/lary.30105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To identify the differences in sensitivity and accuracy between ultrasound-guided and palpation-guided fine needle aspirations (FNA) of suspicious lymph nodes in patients with human papillomavirus (HPV) (+) oropharyngeal squamous cell carcinoma (OPSCC). Additional objectives included identifying patient specific factors affecting biopsy accuracy and evaluating potential differences in accuracy between fine and core needle biopsies. STUDY DESIGN Retrospective chart review. MATERIALS AND METHODS A retrospective study of diagnostic sensitivity was completed at a single tertiary care center between 1/1/2006-12/31/2016. Participants included patients who underwent pretreatment FNA biopsy with HPV(+)OPSCC confirmed pathologically following neck dissection or excisional lymph node biopsy. A true positive (TP) on FNA biopsy was defined as an FNA biopsy concerning for squamous cell carcinoma (SCC) that was confirmed on excisional biopsy or neck dissection. A false negative (FN) was defined as a negative FNA but metastatic disease identified on excisional biopsy or neck dissection. Sensitivity was calculated as TPs/(TPs + FNs). Sensitivity was compared among techniques using chi-square and Fisher exact tests. RESULTS A total of 209 FNA biopsies among 198 patients were included in the study, including 31 (15%) palpation-guided FNAs, 160 (77%) ultrasound-guided FNAs, and 18 (9%) ultrasound-guided FNA + core biopsies. Sensitivity was significantly different among palpation-guided FNA, ultrasound-guided FNA, and ultrasound-guided FNA + core biopsies (48% vs. 83% vs. 94%, respectively; P < .001) but there was no significant difference in sensitivity between ultrasound-guided FNA versus ultrasound-guided FNA + core biopsies (P = .31). CONCLUSION The use of ultrasound guidance in FNA biopsies of nodal metastases in HPV(+)OPSCC improves sensitivity compared to palpation guidance alone. Ultrasound guided biopsies are preferred in patients with suspected nodal metastasis from HPV(+)OPSCC. LEVEL OF EVIDENCE 3 Laryngoscope, 132:2396-2402, 2022.
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Affiliation(s)
- Travis J Haller
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Linda X Yin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Dontre' Douse
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Joseph N Badaoui
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
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Abstract
Neck masses are a very common clinical problem and it remains a diagnostic challenge due to multiple differential diagnoses ranging from benign to severe etiologies. All physicians should equip themselves with knowledge of common and locally prevalent causes of neck masses and manage them accordingly. We present a case of a young patient with no prior medical history who developed cervical tuberculous lymphadenitis. We discuss the physical examination, evolution, diagnosis, and treatment of the case.
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Hutchins T. Image Guided Head and Neck Biopsies: From Superficial to Deep. Tech Vasc Interv Radiol 2021; 24:100769. [PMID: 34861969 DOI: 10.1016/j.tvir.2021.100769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Image guided head and neck biopsies are indicated for the evaluation of primary and metastatic neoplasm or suspected infection. They are often requested for non-palpable lesions or those with non-diagnostic palpation guided biopsies. For neoplasms, they are helpful in planning extent of surgery and nodal dissection, consideration of preoperative chemo-radiation, and in cases where primary treatment may be non-operative (i.e. lymphoma, HPV related oral squamous cell carcinoma (SCCa). For suspected infection, image guided biopsies are useful in identifying microorganisms to tailor appropriate antibiotic therapy. In this article, we review the basics of head and neck biopsies, including pre-procedure evaluation, when to consider moderate IV sedation in addition to local anesthesia, whether to perform fine-needle aspiration (FNA) or core needle biopsy (CNB), and selection of ultrasound (US) versus computed tomography (CT) for image guidance. This is followed by discussion with case examples of needle trajectories that can be used to safely target deep lesions of the head and neck with CT guidance.
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Affiliation(s)
- Troy Hutchins
- Neuroradiology Division, Department of Radiology and Imaging Sciences, Associate Professor of Radiology, University of Utah, Salt Lake City, UT.
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Abstract
Neck masses are common physical examination findings seen in the outpatient setting but identifying an underlying cause can be challenging. A careful medical history should be obtained, and a thorough physical examination should be performed, which will guide the need for follow-up examination with imaging, biopsies, and specialist referrals. The goal of this article is to provide a working framework to evaluate and manage some of the most common causes of adult neck masses.
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Affiliation(s)
- Kevin Chorath
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
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Kamran M, Wallace AN, Adewumi A. Interventional Management of Head and Neck Tumors. Semin Intervent Radiol 2020; 37:157-165. [PMID: 32419728 DOI: 10.1055/s-0040-1709157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Advancements in medical imaging and device technology allow minimal invasive procedures for the diagnosis and treatment of various disorders. For the management of tumors in head and neck region, these image-guided interventions play essential role in the often used multidisciplinary approach. Tissue sampling under ultrasound or computed tomography guidance is generally the first step to reach a pathological diagnosis. For head and neck tumors with high vascularity, embolization using particulate matter, liquid embolic agents, or coils is used to achieve successful tumor resection with minimal blood loss. Hemorrhage related to head and neck tumors can be evaluated and managed with endovascular techniques with minimal morbidity and mortality. Intra-arterial chemotherapy, radiofrequency ablation, and cryotherapy are new techniques for the management of advanced head and neck cancer which may serve as an alternative to achieve locoregional control and survival when curative resection may not be feasible.
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Affiliation(s)
- Mudassar Kamran
- Department of Radiology, UAMS College of Medicine, Little Rock, Arkansas
| | - Adam N Wallace
- Department of Neurointerventional Surgery, Ascension Columbia St. Mary's Hospital, Milwaukee, Wisconsin
| | - Amole Adewumi
- Department of Radiology, UAMS College of Medicine, Little Rock, Arkansas
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9
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Accuracy and effectiveness of ultrasound-guided core-needle biopsy in the diagnosis of focal lesions in the salivary glands. Eur Radiol 2018; 28:2934-2941. [DOI: 10.1007/s00330-017-5295-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 11/25/2017] [Accepted: 12/27/2017] [Indexed: 01/07/2023]
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10
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Abstract
Imaging plays a multifaceted role in the diagnosis and characterization of head and neck oncological patients and is integral to their care. Given the complexity of treatment, a multimodality approach is often necessary. With the advent of new technologies, imaging can also be used to predict tumor behavior and treatment response. In this chapter, with selected case examples, we describe the various imaging modalities available and offer suggestions on their utilization.
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Affiliation(s)
- Ravi Prasad
- Cedars-Sinai Medical Center, Los Angeles, USA.
| | - Beth Chen
- City of Hope National Medical Center, Duarte, USA
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11
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Veltri A, Bargellini I, Giorgi L, Almeida PAMS, Akhan O. CIRSE Guidelines on Percutaneous Needle Biopsy (PNB). Cardiovasc Intervent Radiol 2017; 40:1501-1513. [PMID: 28523447 DOI: 10.1007/s00270-017-1658-5] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 04/20/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Andrea Veltri
- Radiology Unit, Oncology Department, San Luigi Gonzaga Hospital, University of Torino, Regione Gonzole, 10, 10043, Orbassano, Turin, Italy.
| | - Irene Bargellini
- Department of Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56100, Pisa, Italy
| | - Luigi Giorgi
- Department of Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56100, Pisa, Italy
| | | | - Okan Akhan
- Department of Radiology, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
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12
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Joo BY, Jang AL, Lee JH, Park HS, Kang MK, Hong JC. Application of ultrasound-guided pigtail catheter drainage for abscesses in the head and neck. Clin Otolaryngol 2017; 42:1087-1091. [PMID: 28296017 DOI: 10.1111/coa.12864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2017] [Indexed: 11/27/2022]
Affiliation(s)
- B Y Joo
- Department of Otolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - A L Jang
- Department of Medical Engineering, Dong-A University Graduate School, Busan, Korea
| | - J H Lee
- Department of Radiology, Dong-A University College of Medicine, Busan, Korea
| | - H S Park
- Department of Otolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - M K Kang
- Department of Otolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - J C Hong
- Department of Otolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
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