Efficacy of transcutaneous computed tomography--guided fine needle aspiration biopsy in patients with laryngeal squamous cell carcinoma, probable failed radiation therapy, and negative transmucosal biopsies

US-guided transcutaneous tru-cut biopsy of laryngo-hypopharyngeal lesions

OBJECTIVE

To evaluate the feasibility and performance of ultrasound-guided transcutaneous tru-cut biopsy (USGTCB) in selected patients (with stenosis of airways or difficult intubation or contraindication to general anaesthesia) with untreated or previously treated suspicious laryngo-hypopharyngeal masses.

METHODS

Biopsies were performed with a free-hand technique by a single radiologist. Thirty-six USGTCBs were scheduled in 34 patients (24 males, 10 females; age range 47-95 years). Two USGTCBs were not performed, as lesions were not detectable: therefore, 16 USGTCBs were performed for an untreated mass suspicious for malignancy and 18 were performed for a mass suspicious for recurrence after radiotherapy alone, or associated with endoscopic laser surgery or chemotherapy.

RESULTS

USGTCB diagnosed 25 squamous cell carcinomas (73.5%) and nine benign lesions (26.5%); no false positives and two false negatives were reported, both in patients previously treated with radiotherapy. The sensitivity, specificity, positive and negative predictive value of the technique was 92.5%, 100%, 100% and 77.7% respectively, with no major complications.

CONCLUSION

Although biopsy under microlaryngoscopy remains the "gold-standard" technique, USGTCB is feasible, carries the advantages of avoiding general anaesthesia, is suitable for outpatients and is cost-effective. If applied to selected patients, it could be considered for the histological diagnosis of both primary and recurrent laryngo-hypopharyngeal masses.

Ultrasound-guided transcutaneous Tru-Cut biopsy to diagnose laryngopharyngeal masses

BACKGROUND

Patients with bulky laryngopharyngeal masses and a relative or absolute contraindication to general anesthesia present diagnostic difficulties. In the current study, the authors assessed the utility of transcutaneous ultrasound-guided Tru-Cut biopsy (USGTCB) under local anesthesia in such individuals.

METHODS

The current report was a prospective, nonrandomized study. Patients meeting the inclusion criteria underwent USGTCB as outpatients.

RESULTS

Ten patients were recruited, 4 of whom had an untreated mass obstructing the laryngeal lumen and 6 of whom were previously treated for laryngeal cancer. All tolerated the procedure well. The only adverse event noted was spontaneously resolving near-syncope in 1 patient. In 9 patients the biopsy was diagnostic: invasive squamous cell carcinoma in 7 patients and chondronecrosis in 2 patients. In the remaining patient, radiologically suspected cricoid chondrosarcoma was confirmed based on the surgical specimen.

CONCLUSIONS

The results of this pilot study are encouraging. USGTCB of laryngopharyngeal masses was found to produce no local morbidity, was diagnostic in each of the 5 patients with suspected disease recurrence after radiotherapy, was feasible in the outpatient setting, and had high sensitivity and specificity. The procedure is particularly useful for patients contraindicated for general anesthesia or those with a risk of tracheotomy due to intubation difficulties.

Preoperative histologic assessment of head and neck lesions using cutting needle biopsy

OBJECTIVE

This study assessed the clinical utility of cutting needle biopsy in which a newly developed Monopty biopsy instrument (MBI) (Monopty, Bard Urologic Division; Covington, Ga) was used in the preoperative assessment of head and neck lesions.

STUDY DESIGN

Needle biopsies were performed with the MBI in 16 cases of head and neck lesions that included lesions in lymph nodes, salivary glands, palate, and soft tissue.

RESULTS

High-quality histopathologic specimens were obtained without complications in all biopsies performed, and the diagnostic target tissue was obtained in 15 of 16 cases. Diagnoses made from MBI needle biopsy specimens were consistent with the final diagnoses made from subsequent surgical materials in 14 cases, and the accuracy rate was 88%. None of the samples demonstrated significant rush artifacts or obscuring blood, both of which are problems commonly associated with manual biopsy techniques.

CONCLUSIONS

This technique offers a safe and effective means of obtaining adequate tissue for the histological assessment of head and neck lesions.