CT-guided neck biopsies can be performed using multiple different approaches depending on the location of the lesion. In almost all approaches, there are critical neural and vascular structures adjacent to the needle tract. A, CT angiogram of the neck flipped vertically to depict prone positioning for a posterior-approach neck biopsy. Neck biopsies in the shaded region would commonly be performed using a posterior approach. In the shaded region, there are no critical neurovascular structures. B, CT angiogram soft-tissue-windowed image of the neck with the patient in a supine position for the paramaxillary approach (white arrow). The needle course is between the maxillary sinus and the mandible adjacent to the facial artery (dashed arrow) through the buccal space. This approach can be used for lesions in the buccal, masticator, parapharyngeal, retropharyngeal, and carotid sheath spaces. The critical structures to avoid include the facial artery (dashed arrow) and the internal carotid artery (black arrow). C, CT angiogram of the neck with the patient in a supine position for anterior-approach biopsies, which can be either medial (black dashed arrow) or lateral (dashed white arrow) to the carotid and jugular vasculature (white oval). These approaches can be used for lesions in the infrahyoid neck and lower cervical vertebrae. The critical structures to avoid include the carotid artery, jugular vein, and vagus nerve (white oval); the trachea (white T); the esophagus (white E); and the thyroid gland (white asterisk). CT angiograms of the neck with the patient in a decubitus position: This positioning will be used for the retromandibular (D), submastoid (E), and subzygomatic (F) approaches denoted by white arrows. Note that the needle will sometimes pass through a portion of the parotid gland for the retromandibular approach (white asterisk). Critical structures to avoid include the carotid (gray arrows) and vertebral arteries (dashed white arrows) with the retromandibular and submastoid approaches and the retromandibular vein in the retromandibular approach because of its proximity to the facial nerve. These approaches can be used for lesions in the deep parotid, parapharyngeal, pharyngeal, and retropharyngeal spaces.

CT-guided head and neck biopsies can be challenging due to the anatomy and adjacent critical structures but can often obviate the need for open biopsy. A few studies and review articles have described approaches to biopsy in the head and neck. This retrospective study evaluated technical considerations, histopathologic yield, and safety in CT-guided head and neck core needle biopsies.


A retrospective review of head and neck biopsies performed from January 2013 through December 2019 was conducted. Clinical diagnosis and indication, patient demographics, mass location and size, biopsy needle type, technical approach, dose-length product, sedation details, complications, diagnostic histopathologic yield, and the use of iodinated contrast were recorded for each case.


A total of 27 CT-guided head and neck core needle biopsies were performed in 26 patients. The diagnostic sample rate was 100% (27/27). A concordant histopathologic diagnosis was obtained in 93% (25/27) of cases. There was a single complication of core needle biopsy, a small asymptomatic superficial hematoma.


Percutaneous CT-guided biopsy of deep masses in the head and neck is safe and effective with careful biopsy planning and has a high diagnostic yield that can obviate the need for open biopsy.

Read this article: https://bit.ly/3oJLKLB


Jeffrey Ross

• Mayo Clinic, Phoenix

Dr. Jeffrey S. Ross is a Professor of Radiology at the Mayo Clinic College of Medicine, and practices neuroradiology at the Mayo Clinic in Phoenix, Arizona. His publications include over 100 peer-reviewed articles, nearly 60 non-refereed articles, 33 book chapters, and 10 books. He was an AJNR Senior Editor from 2006-2015, is a member of the editorial board for 3 other journals, and a manuscript reviewer for 10 journals. He became Editor-in-Chief of the AJNR in July 2015. He received the Gold Medal Award from the ASSR in 2013.

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