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Percutaneous Biopsy of Head and Neck Lesions with CT Guidance: Various Approaches and Relevant Anatomic and Technical Considerations¹

¹ From the Department of Diagnostic Radiology, Unit 325, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030. Recipient of a Magna Cum Laude award for an education exhibit at the 2005 RSNA Annual Meeting. Received May 16, 2006; revision requested July 25 and received August 22; accepted August 23. R.M. is a research consultant for Sirtex Medical (Lake Forest, Ill); M.E.H. is a stockholder in Pfizer (New York, NY), General Electric (Fairfield, Conn), and St Jude Medical (St Paul, Minn); all other authors have no financial relationships to disclose. Address correspondence to S.G. (e-mail: sgupta{at}di.mdacc.tmc.edu).

Deep-seated head and neck lesions, which traditionally were evaluated by surgical means, are now accessible with less invasive computed tomography–guided percutaneous needle biopsy techniques. Major vessels, the trachea, and osseous structures like the maxilla, mandible, and vertebrae often preclude direct access to these lesions. It is important to understand the anatomy relevant to safe access route planning and the techniques, advantages, and limitations associated with various approaches used for percutaneous biopsy of head and neck lesions. For biopsy of suprahyoid head and neck lesions, including those of the skull base and upper cervical vertebrae, various approaches such as the subzygomatic, retromandibular, paramaxillary, submastoid, transoral, and posterior approaches can be used. Lesions in the infrahyoid portion of the neck and lower cervical vertebrae can be accessed with the anterolateral approach (between the airways and the carotid sheath), posterolateral approach (posterior to the carotid sheath), and direct posterior approach. The location and extent of the lesions and their relationship to adjacent structures influence the choice of the trajectory to use. Careful planning of the procedure and considerable familiarity with head and neck anatomy are necessary for a biopsy that is both precise and safe.

© RSNA, 2007