Image-Guided Fine-Needle Aspiration of the Head and Neck

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Abstract
FINE-NEEDLE aspiration (FNA) biopsy has become a well-established technique in the diagnosis, staging, and follow-up of patients with head and neck lesions. Endocrinologists and otorhinolaryngologists use FNA to provide rapid diagnostic information regarding palpable masses of the thyroid gland, salivary glands, and cervical lymph nodes. However, the clinical assessment of deep-seated or poorly localized masses in this region is highly challenging owing to the complex anatomy and wide range of lesions. A transmucosal, peroral FNA approach to lesions in the parapharyngeal space can yield useful results, with reported accuracy rates ranging from 77%1 to 88%.2 However, this approach is accompanied by risk to carotid and jugular vessels and the facial nerve. Also, there are procedural limitations regarding the stabilization of the lesion and the range of the angle of approach that can result in false-negative rates as high as 19%.3A transoral open biopsy is generally contraindicated for the evaluation of these lesions owing to unacceptable morbidity. To minimize these limitations, FNA has been paired with imaging-guided localization for the cytologic assessment of deep-seated or poorly localized lesions. The current study evaluates the diagnostic utility of computed tomography (CT)– and ultrasound-guided FNA of masses in the head and neck.