Image Guided Head and Neck Biopsies: From Superficial to Deep

Image guided head and neck biopsies are indicated for the evaluation of primary and metastatic neoplasm or suspected infection. They are often requested for non-palpable lesions or those with non-diagnostic palpation guided biopsies. For neoplasms, they are helpful in planning extent of surgery and nodal dissection, consideration of preoperative chemo-radiation, and in cases where primary treatment may be non-operative (i.e. lymphoma, HPV related oral squamous cell carcinoma (SCCa). For suspected infection, image guided biopsies are useful in identifying microorganisms to tailor appropriate antibiotic therapy. In this article, we review the basics of head and neck biopsies, including pre-procedure evaluation, when to consider moderate IV sedation in addition to local anesthesia, whether to perform fine-needle aspiration (FNA) or core needle biopsy (CNB), and selection of ultrasound (US) versus computed tomography (CT) for image guidance. This is followed by discussion with case examples of needle trajectories that can be used to safely target deep lesions of the head and neck with CT guidance.