Cunningham Jane D, McCusker Mark W, Power Sarah, PearlyTi Joanna, Thornton John, Brennan Paul, Lee Michael J, O'Hare Alan, Looby Seamus
Department of Radiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland,
Cardiovasc Intervent Radiol. 2015 Apr;38(2):422-9. doi: 10.1007/s00270-014-0922-1. Epub 2014 Jun 18.
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.
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.
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.
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.
由于头颈部区域解剖结构复杂，对头颈部病变进行组织采样具有挑战性，有时需要进行开放性手术活检。然而，许多患者因合并症而不适合进行手术。因此，我们评估了CT引导在头颈部肿块组织病理学诊断中的应用。
使用科室CT介入程序数据库，对2009年4月至2012年8月期间接受CT引导下的头颈部肿块粗针活检的所有连续患者（n = 22）进行回顾性分析。每次活检的目的是对临床检查或影像学检查中发现的可疑头颈部病变患者进行肿瘤诊断的确定或排除。患者接受清醒镇静，由经验丰富的神经放射科医生使用16层多排螺旋CT成像引导（德国西门子医疗解决方案公司的Somatom Definition）进行18G半自动粗针活检。分析每次活检的组织病理学结果。
22例活检中有16例（73%）获得了病理诊断。活检的解剖部位包括：咀嚼肌间隙（n = 7）、咽旁间隙（n = 3）、腮腺（n = 3）、颈动脉间隙（n = 3）、椎旁间隙（n = 3）、咽部（n = 2）和咽后间隙（n = 1）。6例活检（27%）因组织采样不足而未得出诊断结果，特别是活检样本量小以及由于广泛坏死未能对真正的采样部位进行活检。未发生重大并发症。
使用CT引导对头颈部肿块进行粗针活检是建立组织病理学诊断的有效方法，减少了诊断性开放性手术活检和全身麻醉的需求。
