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Jordan R, Shlapak D, Benson J, Diehn F, Kim D, Lehman V, Liebo G, Madhavan A, Morris J, Morris P, Verdoorn J, Carr C. Percutaneous CT-Guided Core Needle Biopsies of Head and Neck Masses: Review of 184 Cases at a Single Academic Institution, Common and Special Techniques, Diagnostic Yield, and Safety. AJNR Am J Neuroradiol 2022; 43:117-124. [PMID: 34887246 PMCID: PMC8757546 DOI: 10.3174/ajnr.a7348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/14/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Percutaneous CT-guided core needle biopsies of head and neck lesions can be safely performed with vigilant planning. This largest-to-date single-center retrospective study evaluates multiple approaches with consideration of special techniques and examines the histopathologic yield. MATERIALS AND METHODS Retrospective review of CT-guided core biopsies of head and neck lesions from January 1, 2010, to October 30, 2020, was performed. We recorded the following: patient demographics, sedation details, biopsy needle type and size, lesion location and size, approach, patient positioning, preprocedural intravenous contrast, proceduralists' years of experience, complications, and pathology results. RESULTS One hundred eighty-four CT-guided core biopsies were evaluated. The initial diagnostic yield was 93% (171/184). However, of 43/184 (23%) originally "negative for malignancy" biopsies, 4 were eventually positive for malignancy via rebiopsy/excision, resulting in a 2% false-negative rate and an adjusted total diagnostic yield of 167/184 (91%). Biopsies were performed by 16 neuroradiologists with variable experience. The diagnostic yield was essentially the same: 91% (64/70) for proceduralists with ≤3 years' experience, and 90% (103/114) with >3 years' experience. The diagnostic yield was 93% (155/166) for lesions of >10 mm. The diagnostic yield per biopsy needle gauge was the following: 20 ga, 81% (13/16); 18 ga, 93% (70/75); 16 ga, 90% (64/71); and 14 ga, 91% (20/22). There were 4 asymptomatic hematomas, with none requiring intervention. CONCLUSIONS Percutaneous CT-guided core needle biopsies are safe procedures for superficial and deep head and neck lesions with a high diagnostic yield. Careful planning and special techniques may increase the number of lesions accessible percutaneously while minimizing the risk of complications.
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Affiliation(s)
- R.W. Jordan
- From the Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - D.P. Shlapak
- From the Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - J.C. Benson
- From the Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - F.E. Diehn
- From the Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - D.K. Kim
- From the Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - V.T. Lehman
- From the Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - G.B. Liebo
- From the Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - A.A. Madhavan
- From the Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - J.M. Morris
- From the Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - P.P. Morris
- From the Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - J.T. Verdoorn
- From the Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - C.M. Carr
- From the Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota
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