Biopsy Techniques for Lesions of the Head and Neck

The head and neck area is an anatomical region containing a set of complex structures giving rise to a diversity of lesions requiring biopsy with histological or cytological study. The upper aerodigestive tract contains a number of body cavities lined by squamous or respiratory epithelium. These surfaces may give rise to squamous dysplasias, squamous cell carcinomas, and, on occasion, a variety of adenocarcinomas. Such lesions are usually biopsied by open biopsy, grasp biopsy, or curettage. Other structures within the head and neck region include the salivary glands, thyroid, cervical lymph nodes, and soft tissues of the neck. These structures are less easily accessed for biopsy and are usually investigated by fine-needle aspiration (FNA), core needle biopsy, or incisional biopsy, the latter often combined with frozen section evaluation. The present chapter examines the biopsy techniques useful in the evaluation of lesions presenting as cervical lymphadenopathy, salivary gland nodules, thyroid nodules, or soft tissue masses. This chapter examines the relative advantages and disadvantages of core biopsy, fine-needle aspiration, and incisional or excisional biopsy with or without frozen section evaluation.