Medical Student University of Pennsylvania Philadelphia, Pennsylvania, United States
Introduction: Percutaneous computed tomography (CT)-guided biopsies are routinely performed in the appendicular and axial skeleton; however, data are limited for skull base and deep facial approaches. Furthermore, the limited experience primarily describes CT-guided-fine needle aspiration (FNA) techniques which often require multiple passes until eventual conversion to a core-tissue biopsy (CTB) system. No studies have compared CT-guided biopsy types (FNA versus CTB) in this region. Herein we evaluate the safety profile, feasibility, and diagnostic yield of CT-guided FNA and CTB outpatient biopsies for skull base and deep facial lesions.
Methods: Patients undergoing percutaneous CT-guided CTB and/or FNA of skull base lesions between 2018-2022 were retrospectively enrolled. Per neuroradiologist discretion, either FNA was attempted first, with conversion to CTB if nondiagnostic, or CTB was attempted upfront. Diagnostic yield and patient outcomes were examined using standard statistical techniques.
Results: Eighteen patients underwent CT-guided biopsies. Anatomic locations biopsied included the petrous ridge, temporal bone, and clivus. Thirteen patients underwent FNA first, eight of whom converted to CTB. Five patients underwent upfront CTB. The FNA first group had a more procedural passes than the upfront CTB group (12.2 ± 4.3 vs 5.8 ± 2.6; p=0.004). There were no significant differences in mean procedure time between groups (FNA first: 78.5 ± 51.4 min, CTB first: 47.4 ± 30.3 min; p=0.22). FNA had a lower diagnostic yield than CTB (23.1% vs 100%; p< 0.001). Median lengths of stay were similar between groups. No patients experienced adverse procedure-related events or 30-day readmissions.
Conclusion : These findings underscore the excellent diagnostic yield and safety profile of outpatient, minimally-invasive CT-guided CTB for skull base and deep facial lesions. Additionally, performing CT-guided CTB upfront required fewer needle passes than attempting FNA first. Thus, percutaneous CT-guided CTB biopsy provides a reasonable outpatient option to consider prior to a more invasive open approach.
