Emory Radiology
Ultrasound- and Computed Tomography-Guided
Needle Biopsy of the Neck
What Is a Fine Needle Aspiration?
A fine needle aspiration (FNA) is a minimally invasive
procedure that involves removing cells from a suspicious
area using a needle and examining them under a
microscope to make a diagnosis. A pathologist is on
site during the procedure to determine whether the
sample contains enough cells to make a diagnosis.
A CT scanner consists of a table that moves through
the center of a short tunnel. The patient lies on the
table and is slid into the tunnel, where the CT scanner
is used to generate cross-sectional images of the neck.
How Do Radiologists Decide Whether to Use
Ultrasound or CT for Image Guidance?
Your radiologist will decide whether CT or ultrasound
is best for your biopsy based on the size and location of
your lesion
What Are the Common Indications for
Ultrasound-Guided FNA or Biopsy in the
Head and Neck?
What Is an Ultrasound-Guided Neck Biopsy?
1. Suspicious lymph nodes: Suspicious lymph nodes
may be identified on ultrasound, magnetic resonance
imaging (MRI), CT scans or positron-emission
tomography/CT (PET/CT) scans. These images may
suggest a diagnosis, but a sample of tissue is needed to
make a definite diagnosis and plan treatment.
In an ultrasound-guided neck biopsy, such as FNA,
real-time ultrasound images are used to help the doctor
guide a needle to the suspect lesion inside the neck to
obtain a tissue sample. This procedure is used when the
lesion is too deep within the neck to be felt.
2. Thyroid nodules: The thyroid gland is located in
front of the neck, just below a man’s Adam’s apple, and
is shaped like a butterfly. Nodules are often detected by
imaging examinations. Suspicious nodules will need to
be sampled using FNA or biopsy.
An ultrasound scanner consists of a console containing a
computer, a video display screen and a transducer. The
transducer is a small handheld device that uses sound
waves to create images of structures inside the body.
The ultrasound image is immediately visible on a
nearby video display screen. Ultrasound uses nonionizing
radiation, so an ultrasound procedure does not involve
the same radiation exposure as an X-ray.
3. Suspicious tissue in the thyroid bed: After removal
of the thyroid gland (thyroidectomy), patients may be
followed with imaging tests to identify any suspicious
tissue that may develop in the area of the previously
removed thyroid gland, called the “thyroid bed.”
What Is a Computed Tomography-Guided
Neck Biopsy?
A computed tomography-guided neck biopsy, or CTguided biopsy, uses real-time CT images to help the
doctor guide a needle to the suspect lesion inside the
neck to obtain a tissue sample. Occasionally, intravenous
(IV) contrast is needed to help the radiologist identify
and target the lesion prior to the biopsy. The CT image
is immediately available on a monitor, allowing your
radiologist to view the biopsy target.
What Are the Common Indications for CTGuided FNA or Biopsy in the Head and Neck?
1. Lymph nodes or masses that are not completely
identifiable using ultrasound.
2. Lesions near the skull base: CT is optimal for
localizing these lesions.
How Should I Prepare for My Procedure?
Usually, no special preparations are required for these
procedures. However, you should notify your physician
if you are taking any blood thinning medications, such
as Coumadin (warfarin), Lovenox (enoxaparin) or
heparin, or if you have bleeding problems.
In addition, some CT-guided tissue biopsies may require
sedation. In these cases, patients will be instructed to
have nothing to eat or drink for six hours prior to the
procedure.
How Is the Procedure Performed?
The needle used in FNA is similar to those used to
draw blood, only longer and thinner. All ultrasoundand CT-guided procedures will be supervised by a
specially trained radiologist.
Who Interprets the Results and
How Do I Get Them?
A pathologist examines the sample during the procedure
to determine whether there is enough tissue to have
a good chance of making a diagnosis. A preliminary
diagnosis may be available at the time of your biopsy,
but the final diagnosis takes up to one week.
Ultrasound guided: An ultrasound transducer and a
small amount of gel will be placed on your neck to locate
the target tissue. After cleaning and numbing the area,
the radiologist will then insert a needle through the
skin and gently take small samples of tissue.
CT guided: You will be positioned on the CT table
and a scan will be performed to locate the lesion. After
cleaning and numbing the area, the radiologist will
then insert a needle through the skin and gently take
small samples of tissue.
It may take three to five needle passes to obtain
adequate tissue for the pathologist to make a diagnosis.
Once the biopsy is complete, pressure will be applied to
the area and a bandage will be placed if necessary. No
sutures are needed.
What Will I Experience During and After the
Procedure?
What Are the Benefits and Risks??
Benefits
• FNA is a reliable method of obtaining tissue samples
that can help determine whether a nodule or
lymph node is benign (non-cancerous) or malignant
(cancerous).
• FNA is less invasive than a surgical biopsy, which
involves an incision in the skin and the use of local
or general anesthesia.
• Recovery time is brief, and patients can soon resume
their usual activities.
During the test, you will lie on your back or your
side. Your head may be tipped slightly backwards.You
may feel some pressure during the biopsy and mild
discomfort as the needle is moved. You will be asked
to remain still and not to cough or talk during the
procedure.
Risks/Limitations
• Bleeding or infection at the site of the biopsy (rare).
• Injury to adjacent structures from the needle (rare).
• Insufficient tissue to make a diagnosis, requiring a
repeat aspiration or another procedure such as a
surgical biopsy to make the diagnosis (less than
10% of the time).
If no IV medication or sedation was administered, you
will generally be monitored for up to an hour following
the procedure, after which you may return home. If IV
medication or sedation was used, you may be monitored
for at least one hour before being discharged.
Alternatives
• Surgical removal/biopsy.
• Continued imaging surveillance of the suspicious
area.
The biopsy site may be sore for one or two days. You
may take nonprescription pain medicine to relieve
any discomfort. However, you should not take any
medication that contains aspirin or ibuprofen for 24
hours following the procedure.
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Questions/Concerns
After your doctor orders the procedure, you will
be contacted by the Interventional Radiology
scheduling service.
If you have any questions or concerns regarding
the procedure (before or after), please call the
Emory Interventional Radiology Patient Care
Coordinator at 404-712-0566, Monday through
Friday between 7 a.m. and 6 p.m.