title: Accessible or inaccessible? Diagnostic efficacy of CT-guided core biopsies of head and neck masses.
abstract: OBJECTIVE
  Tissue sampling of lesions in the head and neck is challenging due to complex regional anatomy and sometimes necessitates open surgical biopsy. However, many patients are poor surgical candidates due to comorbidity. Thus, we evaluated the use of CT guidance for establishing histopathological diagnosis of head and neck masses.
  
  
  METHODS
  All consecutive patients (n = 22) who underwent CT-guided core biopsy of head or neck masses between April 2009 and August 2012 were retrospectively reviewed using the departmental CT interventional procedures database. The indication for each biopsy performed was to establish or exclude a diagnosis of neoplasia in patients with suspicious head or neck lesions found on clinical examination or imaging studies. Patients received conscious sedation and 18 G, semiautomated core needle biopsies were performed by experienced neuroradiologists using 16-slice multidetector row CT imaging guidance (Somatom Definition Siemens Medical Solutions, Germany). Histopathology results of each biopsy were analysed.
  
  
  RESULTS
  Sixteen of 22 biopsies that were performed (73 %) yielded a pathological diagnosis. Anatomic locations biopsied included: masticator (n = 7), parapharyngeal (n = 3), parotid (n = 3), carotid (n = 3), perivertebral (n = 3), pharyngeal (n = 2), and retropharyngeal (n = 1) spaces. Six biopsies (27 %) were nondiagnostic due to inadequate tissue sampling, particularly small biopsy sample size and failure to biopsy the true sampling site due to extensive necrosis. No major complications were encountered.
  
  
  CONCLUSIONS
  The use of CT guidance to perform core biopsies of head and neck masses is an effective means of establishing histopathological diagnosis and reduces the need for diagnostic open surgical biopsy and general anaesthesia.
authors.affiliation: Department of Radiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland, janecunningham0708@gmail.com.
authors.forename: Jane D
authors.initials: JD
authors.lastname: Cunningham
authors.forename: Mark W
authors.initials: MW
authors.lastname: McCusker
authors.forename: Sarah
authors.initials: S
authors.lastname: Power
authors.forename: Joanna
authors.initials: J
authors.lastname: PearlyTi
authors.forename: John
authors.initials: J
authors.lastname: Thornton
authors.forename: Paul
authors.initials: P
authors.lastname: Brennan
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lee
authors.forename: Alan
authors.initials: A
authors.lastname: O'Hare
authors.forename: Seamus
authors.initials: S
authors.lastname: Looby
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D061705:Image-Guided Biopsy; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009333:Neck / Q000000981:diagnostic imaging / Q000473:pathology; D015641:Radiography, Interventional; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055815:Young Adult