How safe is the use of ultrasound-guided cutting needle biopsy in the head and neck?

To analyse the risks and potential complications of cutting needle biopsy (CNB) for head and neck lesions, which have not been fully discussed previously. We performed a systematic clinicopathological quality assessment study of 200 patients with cervicofacial lesions who underwent 444 CNB procedures with a semiautomatic biopsy gun. Adequate target tissue was obtained in 181 patients and revealed malignancy in 127 patients (70.2%). Follow-up uncovered 2 (1.1%) false-negative results. Emphasis was placed on the analysis of 4 minor and 2 major complications that were recorded. One patient suffered from a cerebrovascular event and died after dissection of a distinctively kinked carotid artery. The risks of CNB are discussed and compared to fine-needle aspiration cytology (FNAC) and open biopsy and related to series of parameters. CNB is a safe and reliable technique in the majority of cases but its risks in the head and neck are not negligible due to the proximity of major neurovascular structures and airways. We recommend special attention after neck surgery and radiotherapy and when the target is not clearly circumscribed and is close to major vessels.