Abstract
Purpose
Although CT-guided biopsies of the calvarium, skull base, and orbit are commonly performed, the best approaches, efficacy, and safety of such procedures remain scantly described in the literature. This retrospective review of percutaneous biopsies illustrates several approaches to challenging biopsy targets and provides a review of procedural planning considerations and histopathologic yield.
Methods
A retrospective review of CT-guided biopsies of the skull base, calvarium, and orbit between 1/1/2010 and 10/30/2020 was conducted. Patient demographics and procedural factors were recorded, including lesion size and location, biopsy approach, and needle gauge. Outcomes were also noted, including CT dose length product, complications, and histopathologic yield.
Results
Sixty-one CT-guided biopsies were included in the final analysis: 34 skull base, 23 calvarial, and 4 orbital lesions. The initial diagnostic yield was 32/34 (94%) for skull base lesions, with one false-negative and one non-diagnostic sample. Twenty-one of twenty-three (91%) biopsies in the calvarium were initially diagnostic, with one false-negative and one non-diagnostic sample. In the orbit, 4/4 biopsies were diagnostic. The total complication rate for the cohort was 4/61 (6.6%). Three complications were reported in skull base procedures (2 immediate and 1 delayed). A single complication was reported in a calvarial biopsy, and no complications were reported in orbital biopsies.
Conclusion
Percutaneous CT-guided core needle biopsies can be performed safely and with a high diagnostic yield for lesions in the skull base, calvarium, and orbit.
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References
Álvarez Jáñez F, Barriga LQ, Iñigo TR, Roldán LF (2021) Diagnosis of skull base osteomyelitis. Radiographics 41(1):156–174
Gupta S, Henningsen JA, Wallace MJ, Madoff DC, Morello FA Jr, Ahrar K, Murthy R, Hicks ME (2007) Percutaneous biopsy of head and neck lesions with CT guidance: various approaches and relevant anatomic and technical considerations. Radiographics 27(2):371–390
Hillen TJ, Baker JC, Long JR, Friedman MV, Jennings JW (2020) Percutaneous CT-guided core needle biopsies of head and neck masses: technique, histopathologic yield, and safety at a single academic institution. AJNR Am J Neuroradiol 41(11):2117–2122
Wang J, Guo CB, Zhu JH, Guo YX, Yu GY, He Y, Zhang WB, Zhang Y, Peng X, Liu XJ, Liu YP, Gu XM, Tian WD, Lu L, Li ZB, Zhang SL, Shen GF, Bao S, Li TJ, Fu KY, Society Of Oral And Maxillofacial Surgery, Chinese Stomatological Association (2020) Expert consensus on procedures and operations of navigation-guided needle biopsy techniques for skull base tumours. Chin J Dent Res 23(1):27–32. https://doi.org/10.3290/j.cjdr.a44333
Pileggi M, Ventura E, Di Napoli A, Piantanida R, Muto M, Cardia A, Cianfoni A (2022) Gantry-needle-target alignment technique for CT-guided needle approaches to the skull base and cranio-cervical junction. Neuroradiol 64(10):2039–2047. https://doi.org/10.1007/s00234-022-03005-9
Gandhi DR, Gemmete JJ, Ansari SA, Gujar SK, Mukherji SK (2008) Interventional neuroradiology of the head and neck. Am J Neuroradiol 29(10):1806–1815
Learned KO, Lev-Toaff AS, Brake BJ, Wu RI, Langer JE, Loevner LA (2016) US-guided biopsy of neck lesions: the head and neck neuroradiologist’s perspective. Radiographics 36(1):226–243
Ortiz O, Bastug D, Ellis B (1996) CT-guided percutaneous lateral suprazygomatic approach for posterior orbital wall biopsy. Skull Base Surg 6(4):249–251
Abrahams JJ (1998) Mandibular sigmoid notch: a window for CT-guided biopsies of lesions in the peripharyngeal and skull base regions. Radiology 208(3):695–699
Zhu JH, Yang R, Guo YX, Wang J, Liu XJ, Guo CB (2021) Navigation-guided core needle biopsy for skull base and parapharyngeal lesions: a five-year experience. Int J Oral Maxillofac Surg 50(1):7–13
Jelinek JS, Murphey MD, Welker JA, Henshaw RM, Kransdorf MJ, Shmookler BM, Malawer MM (2002) Diagnosis of primary bone tumors with image-guided percutaneous biopsy: experience with 110 tumors. Radiology 223(3):731–737
Wilseck ZM, Lin L, Gemmete JJ, Pandey AS, Srinivasan A, Chaudhary N (2021) Skull base neurointerventional techniques. Neuroimaging Clin N Am 31(4):649–664
Sherman PM, Yousem DM, Loevner LA (2004) CT-guided aspirations in the head and neck: assessment of the first 216 cases. Am J Neuroradiol 25(9):1603–1607
DelGaudio JM, Dillard DG, Albritton FD, Hudgins P, Wallace VC, Lewis MM (2000) Computed tomography--guided needle biopsy of head and neck lesions. Arch Otolaryngol Head Neck Surg 126(3):366–370
Omura M, Motamedi K, UyBico S, Nelson S, Seeger L (2011) Revisiting CT-guided percutaneous core needle biopsy of musculoskeletal lesions: contributors to biopsy success. AJR Am J Roentgenol 197(2):457–461
Jordan RW, Shlapak DP, Benson JC, Diehn FE, Kim DK, Lehman VT, Liebo GB, Madhavan AA, Morris JM, Morris PP, Verdoorn JT, Carr CM (2022) Percutaneous CT-guided core needle biopsies of head and neck masses: review of 184 cases at a single academic institution, common and special techniques, diagnostic yield, and safety. AJNR Am J Neuroradiol 43(1):117–124
Hau M, Kim J, Kattapuram S et al (2002) Accuracy of CT-guided biopsies in 359 patients with musculoskeletal lesions. Skeletal Radiol 31:349–353
McKnight CD, Glastonbury CM, Ibrahim M et al (2017) Techniques and approaches for safe, high-yield CT-guided suprahyoid head and neck biopsies. Am J Roentgenol 208:76–83
Connor SEJ, Chaudhary N (2008) CT-guided percutaneous core biopsy of deep face and skull-base lesions. Clin Radiol 63(9):986–994
Wu JS, Goldsmith JD, Horwich PJ, Shetty SK, Hochman MG (2008) Bone and soft-tissue lesions: what factors affect diagnostic yield of image-guided core-needle biopsy? Radiology 248(3):962–970
Tomasian A, Hillen TJ, Jennings JW (2020) Bone biopsies: what radiologists need to know. AJR Am J Roentgenol 215(3):523–533
Tomasian A, Hillen TJ, Jennings JW (2019) Percutaneous CT-guided skull biopsy: feasibility, safety, and diagnostic yield. AJNR Am J Neuroradiol 40(2):309–312
Lange MB, Petersen LJ, Nielsen MB, Zacho HD (2021) Validity of negative bone biopsy in suspicious bone lesions. Acta Radiol Open 10(7):20584601211030662
Rana M, Holtmann H, Lommen J, Rana M, Zeller A, Kübler N, Hufendiek K, Hermann E, Gellrich NC, Sproll C (2018) Trajectory-guided biopsy of orbital tumor – technology, principal considerations and clinical implementation. J Craniomaxillofac Surg 46(6):994–1000
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Betting, T., Benson, J., Madhavan, A. et al. Safety and histopathologic yield of percutaneous CT-guided biopsies of the skull base, orbit, and calvarium. Neuroradiology 66, 417–425 (2024). https://doi.org/10.1007/s00234-023-03266-y
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DOI: https://doi.org/10.1007/s00234-023-03266-y