Ultrasonographic biopsy of head and neck masses by a new semi-automatic high-velocity biopsy pistol

Fine needle aspiration biopsy (FNAB) under ultrasound control is an established diagnostic procedure for the head and neck region. Because of the disintegration of tissues,the diagnostic value of the method is limited resulting in only moderate specificity. In a prospective study, we performed a new, semiautomatic biopsy method in patients who had been diagnosed with sonographically confirmed pathologic masses in the head-neck region. This biopsy is carried out with a spring-loaded biopsy pistol which uses a disposable 20-gauge, specially designed cutting needle. Because this method combines the low invasiveness of FNAB with the high specificity of an excisional biopsy,a high tissue quality is obtained. Comparing these bioptic results with those of subsequent excisional biopsies proves that this new method yields a sensitivity of close to 100% for the detection of lymph node metastases of squamous cell carcinomas (SCC). The tissue cylinders have a reproducible size and allow ultrastructural investigations in the transmission electron microscope (TEM) on the ultrastructural level. Due to the excellent tissue preservation in the biopsy cylinders, ultrastructural studies, using transmission electron microscopy, may be carried out with the biopsy material. Furthermore, following paraffin embedding of biopsy cylinders, serial sections may be obtained for special staining techniques,and immunohistological investigations are possible which may serve as an adjunct in the diagnosis of, e.g., lymphoproliferative lesions with a sensitivity of 96%. Summarizing, the new semi-automatic biopsy technique obtains tissue probes of high quality with low invasiveness which enables highly sensitive diagnosis of head and neck lesions.