CT-guided core needle biopsy in ultrasound-inaccessible suprahyoid deep neck spaces.

OBJECTIVES: To assess the diagnostic yield, procedural safety, and concordance with reference standards of CT-guided core needle biopsy (CNB) for ultrasound-inaccessible lesions in the suprahyoid deep neck spaces. MATERIALS AND METHODS: In this retrospective single-center cohort study, 122 CT-guided core needle biopsies in 118 patients between January 2005 and August 2024 were evaluated. Patients lost to follow-up were excluded (n = 9). Procedural characteristics, diagnostic performance, procedural safety, and concordance with surgical pathology were analyzed. RESULTS: Of the 118 included patients, the median age was 59 years, and 70 patients (59.3%) were female. Among 122 CT-guided CNBs, 115 (94.3%) were performed in the suprahyoid deep neck spaces. The diagnostic yield was 93.4% (114/122; 95% CI: 87.6%-96.6%). The histopathologic concordance between CT-guided CNB and surgery was 89.5% (34/38). Minor procedure-related complications occurred in 4.1% (5/122) of all cases. CONCLUSIONS: CT-guided CNB is a reliable diagnostic tool for ultrasound-inaccessible lesions in the suprahyoid deep neck spaces, where complex anatomy may limit needle visualization with ultrasound guidance. These findings support the selective use of CT guidance for tissue diagnosis in anatomically challenging head and neck lesions. KEY POINTS: Question What are the diagnostic yield, procedural safety, and concordance of CT-guided CNB for ultrasound-inaccessible lesions in the suprahyoid head and neck? Findings CT-guided CNB demonstrated a diagnostic yield of 93.4%, surgical concordance of 89.5%, and a minor complication rate of 4.1% in a cohort of suprahyoid lesions. Clinical relevance CT-guided CNB can provide reliable tissue diagnosis for ultrasound-inaccessible lesions in the suprahyoid head and neck. It may serve as a complementary diagnostic tool for anatomically challenging cases in which ultrasound-guided biopsy is not feasible.