Biopsy of Deep-Seated Head and Neck Lesions under Intraoral Ultrasound Guidance
K.T. Wonga,
R.K.Y. Tsangb,
G.M.K. Tsec,
E.H.Y. Yuend and
A.T. Ahujaa
a Department of Diagnostic Radiology & Organ Imaging, The Chinese University of Hong Kong, Hong Kong, China
b Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
c Department of Anatomical & Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
d Department of Radiology, Hong Kong Baptist Hospital, Hong Kong, China
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Fig 1. A 63-year-old man with metastatic left retropharyngeal node from recurrent nasopharyngeal carcinoma.
A, Postgadolinium enhanced, fat-suppressed T1-weighted (repetition time, 550 ms/echo time, 12 ms/number of signal averages, 2) axial MR image at the level of oropharynx shows an enlarged left retropharyngeal lymph node (arrow). Note the close relationship of the lymph node with the left internal carotid artery (arrowhead).
B, Grayscale intraoral sonography in transverse plane reveals a well-defined, solid, round, hypoechoic left retropharyngeal lymph node (arrow) just medial to the left internal carotid artery (arrowhead). The sonographic appearances are suggestive of a malignant node.
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Fig 2. An 82-year-old woman with peripheral nerve sheath tumor in the right parapharyngeal space.
A, Postgadolinium T1-weighted (repetition time, 425 ms/echo time, 13 ms/number of signal averages, 2) axial MR image shows a well-circumscribed heterogeneous mass with both cystic and solid enhancing components in the right parapharyngeal space (arrows). The right lateral oropharyngeal wall is pushed toward the midline.
B, Grayscale intraoral sonography in transverse plane confirms the presence of heterogeneous mixed cystic and solid mass (arrows) underneath the right oropharyngeal mucosa.
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Fig 3. A 40-year-old woman with a pleomorphic adenoma in the deep left parotid space. T1-weighted (A) and postgadolinium enhanced T1-weighted (B) (repetition time, 450 ms/echo time, 13 ms/number of signal averages, 2) axial MR images show a well-circumscribed heterogeneously enhancing mass (arrows) arising from the left parotid space. Note that the left parapharyngeal fat is displaced anteromedially (arrowheads), which suggests parotid space origin of the mass.
C, Grayscale intraoral sonography in the transverse plane shows a well-circumscribed, homogenous, hypoechoic left deep parotid space mass (arrows) underneath the left oropharyngeal mucosa. Note the deep portion of the lesion is not fully examined by this technique.
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Fig 4. A, Basic equipment for intraoral sonography-guided biopsy: intraoral sonography transducer (i); 22-gauge Franseen needle (ii); 10% xylocaine spray (iii).
B, Photograph shows the procedure of intraoral sonography-guided biopsy.
C, Schematic diagram illustrates the biopsy needle pathway in relation to positions of the intraoral sonography transducer and the lesion. M = mass; N = needle; OM = oropharyngeal mucosa; T = transducer.
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