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Neuroradiologie Scan 2016; 06(02): 133-155
DOI: 10.1055/s-0042-105531
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© Georg Thieme Verlag KG Stuttgart · New York

Ultraschallgesteuerte Biopsie von Kopf-Hals-Pathologien aus der Sicht des Neuroradiologen[1]

US-guided biopsy of neck lesions: the head and neck neuroradiologist’s perspective
Kim O. Learned
,
Anna S. Lev-Toaff (†)
,
Bonnie J. Brake
,
Roseann I. Wu
,
Jill E. Langer
,
Laurie A. Loevner
Further Information

Publication History

Publication Date:
21 April 2016 (online)

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Zusammenfassung

Die ultraschallgesteuerte perkutane Biopsie einer Läsion am Hals ist eine kosteneffiziente, sichere und zielführende diagnostische Maßnahme ohne Strahlenbelastung. Sie ermöglicht eine Sichtkontrolle der Nadelposition in Echtzeit. Das hat den Vorteil, dass die Vorschubrichtung der Nadel sofort korrigiert und die Gewebeentnahme infolgedessen ohne größere Risiken an der richtigen Stelle und in kurzer Zeit durchgeführt werden kann. Eine effektive ultraschallgesteuerte Biopsie erfordert Erfahrung mit der Technik, Gründlichkeit bei der klinischen Beurteilung und Geschicklichkeit bei der Durchführung der Biopsie. Gute Kenntnisse der Anatomie und Pathologie von Kopf und Hals erlauben dem Neuroradiologen die Korrelierung der Ultraschallbildgebung mit transversalen Schnittbildern und erleichtern deren Interpretation. Vertrautheit mit den gängigen Halsoperationen und -rekonstruktionen und die Fähigkeit zur Beurteilung von Aufnahmen des behandelten Halses in verschiedenen Bildgebungsmodalitäten sind von unschätzbarem Wert bei der Bestimmung des Zieles einer ultraschallgesteuerten Biopsie bei Patienten mit behandlungsbedingten Veränderungen der anatomischen Gegebenheiten. Nach Knoten in der Schilddrüse kommen die folgenden Raumforderungen am Hals von Erwachsenen häufig vor: Lymphadenopathien, Kopf-Hals-Malignome, Speicheldrüsenneoplasien, Nervenscheidentumoren sowie entzündliche und infektiöse Herde. Auch die diagnostische Expertise mit Blick auf die Bildgebungsmerkmale der genannten Erkrankungen und auf ihre Differenzialdiagnose spielt eine wichtige Rolle bei der Wahl der Biopsietechnik und der Gewinnung einer geeigneten Gewebeprobe für die Diagnose einschließlich Materials für zusätzliche Laboruntersuchungen. Einer Einteilung in anatomische Zonen folgend skizziert dieser Artikel die praktischen Überlegungen bei der Auswahl der Patienten, bei der methodischen Analyse der präprozeduralen Querschnittsbildgebung und deren Korrelierung mit der Beurteilung der Echtzeit-Ultraschallbildgebung sowie bei den allgemeinen Prinzipien zur Optimierung der Ultraschallinstrumentierung und der Biopsietechnik. In geübten Händen ist die Sonografie aufgrund ihrer Vielseitigkeit und ihrer Portabilität eine wertvolle Modalität für die Gewinnung von Gewebeproben von oberflächlichen Kopf- und Halsläsionen.

Abstract

Ultrasonographically (US) guided percutaneous biopsy of a neck lesion is a cost-effective, safe, and diagnostically effective procedure without radiation exposure. The benefit of real-time visualization of the needle location allows for instantaneous maneuvering of the needle trajectory for safe and accurate tissue sampling with short procedural time. Effective US-guided biopsy requires technical experience, strong clinical acumen, and skillful biopsy technique. A neuroradiologist’s knowledge of head and neck anatomy and pathology allows correlation with cross-sectional imaging and enhances the understanding of US imaging evaluation. Familiarity with a spectrum of neck surgeries and reconstructions and expertise in imaging evaluation of the treated neck are invaluable in accurate identification of the target for biopsy in patients with treatment-related altered anatomy using US guidance. After thyroid nodules, the common adult neck masses are lymphadenopathy, head and neck cancer, salivary neoplasms, nerve sheath tumors, and inflammatory and infectious pseudomasses. Diagnostic expertise in the imaging characteristics of these individual pathologic conditions and their differential diagnoses also play an important role in choosing the biopsy technique and in procuring an adequate sample for diagnosis, including material for ancillary laboratory testing. Using an anatomic zone approach, this article illustrates the practical considerations in patient selection, the methodical analysis of preprocedure cross-sectional imaging and its correlation with real-time US evaluation, general principles for optimizing US instrumentation, and biopsy technique. In skillful hands, the versatility and portability of US make it the valuable modality for histologic sampling of superficial head and neck lesions.

1 © 2016 The Radiological Society of North America. All rights reserved. Originally puplished in English in RadioGraphics 2016; 36: 226 – 243. Online published in 10.1148 /rg.2016150087. Translated and reprinted with permission of RSNA. RSNA is not responsible for any inaccuracy or error arising from the translation from English to German.


 

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