title: CT-guided needle biopsy through mandibular area for the diagnosis of nasopharyngeal carcinoma in the parapharyngeal space.
abstract: OBJECTIVE
  The primary submucous type of nasopharyngeal carcinoma (NPC) or the recurrent NPC in the parapharyngeal space is difficult to be diagnosed histologically by conventional biopsy because of the obstruction of the surrounding structures. This study was performed to evaluate the needle biopsy approach through the madibular area into the parapharyngeal space under the guidance of computed tomography (CT) for NPC.
  
  
  METHODS
  Between July 6, 2005 and October 23, 2009, a total of 6 patients were enrolled into the study. Two patients with cervical lymph node metastasis were clinically suspicious of NPC according to their clinical manifestations. However, no cancer cell could be found by repeated nasopharyngeal biopsies followed by histologic examinations. The other 4 patients were diagnosed with recurrent NPCs by magnetic resonance imaging (MRI) or/and positron emission tomography (PET)-CT scan, showing tumors in the parapharyngeal spaces in 3 patients and enlarged retropharyngeal lymph node in 1 patient. The CT-guided puncture was performed through the mandibular skin and the cutting needle biopsy was taken at the parapharyngeal space focus.
  
  
  RESULTS
  All the cutting needle biopsies of projected locations have been performed safely. Finally, all the 7 specimens met the requirement of pathologic diagnosis and the cases were all confirmed histologically to be NPCs. The main complication was mild ache at the puncture point. No blood vessel or nerve was injured and no patient needed special treatment.
  
  
  CONCLUSIONS
  The CT-guided puncture biopsy of the parapharyngeal space through the mandibular area is simple and feasible. It can be an additional option for routine nasopharyngeal biopsy.
authors.affiliation: State Key Laboratory of Oncology in South China, Guangzhou, Guangdong 510060, P. R. China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Su
authors.forename: Chong
authors.initials: C
authors.lastname: Zhao
authors.forename: Wen-Jie
authors.initials: WJ
authors.lastname: Li
authors.forename: Xue-Ying
authors.initials: XY
authors.lastname: Deng
authors.forename: Rui-Fang
authors.initials: RF
authors.lastname: Zeng
authors.forename: Nian-Ji
authors.initials: NJ
authors.lastname: Cui
authors.forename: Tai-Xiang
authors.initials: TX
authors.lastname: Lu
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000379:methods*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D008334:Mandible; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D009364:Neoplasm Recurrence, Local; D010614:Pharynx / Q000473:pathology*; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed