Acad Radiol. 2026 Apr 3:S1076-6332(26)00124-8. doi: 10.1016/j.acra.2026.02.033. Online ahead of print.
ABSTRACT
RATIONALE AND OBJECTIVES: This study aimed to comprehensively compare the diagnostic performance, technical efficacy, and safety profiles of four different approaches for core needle biopsy (CNB) of oropharyngeal and adjacent space lesions: transoral versus percutaneous approaches, each guided by either conventional ultrasound (US) or contrast-enhanced ultrasound (CEUS).
MATERIALS AND METHODS: This retrospective cohort study consecutively enrolled eligible adults who underwent imaging studies showing suspected oropharyngeal, parapharyngeal, retropharyngeal space, and adjacent space tumors from October 2015 to December 2024. From 388 eligible patients (initial cohort: 416), 240 patients were selected using a 1:1:1:1 matched design with percutaneous US-guided CNB as the reference group to form four balanced groups: transoral or percutaneous CNB guided by either conventional US or CEUS (60 patients per group). Matching by age and maximum tumor diameter was performed to balance baseline characteristics among groups. All procedures used 18-G automated cutting needles. The primary outcome was diagnostic concordance between US/CEUS-guided CNB histopathology and the reference standard. The secondary outcomes included imaging concordance (US/CEUS concordance with histopathological reference standard); procedure efficacy (first-puncture success; total number of needle punctures; and overall procedure duration); safety profile, including infection and hemorrhagic complications; and pain assessment. Statistical analyses accounted for the matched design by applying linear models, conditional logistic regression, and generalized estimating equations for continuous, binary, and repeated-measures outcomes, respectively.
RESULTS: Among 240 patients, transoral CEUS guidance demonstrated favorable perioperative outcomes across multiple domains. For procedural precision, first-attempt puncture success was significantly higher with transoral versus transcutaneous approaches (adjusted OR = 2.35, 95% CI: 1.18-4.68, P = 0.015). CEUS significantly reduced puncture attempts compared with conventional US (β = -0.69, 95% CI: -0.84 to -0.53, P < 0.001), with transoral CEUS achieving a notably greater reduction versus transcutaneous conventional US (β = -0.82, 95% CI: -1.04 to -0.60, P < 0.001). Intraoperative blood loss was statistically significantly lower with CEUS guidance overall (β = -0.30, 95% CI: -0.36 to -0.24, P < 0.001), with transoral CEUS showing a relatively greater effect (β = -0.34, 95% CI: -0.43 to -0.25, P < 0.001 vs transcutaneous conventional US). CEUS guidance was associated with a statistically significant prolongation of procedure time compared with US (β = 1.6 min; 95% CI: 1.3-1.9; P< 0.001). For transoral CEUS relative to percutaneous guidance, the prolongation was β = 1.7 min (95% CI: 1.4-2.0; P< 0.001). And transoral CEUS yielded a relatively more favorable pain profile, with significantly lower scores immediately postoperatively (β = -0.72, P < 0.001) and at 24 h (β = -0.40, P < 0.001). Diagnostic accuracy remained uniformly high across all groups (95.0-98.3%), with no significant differences by approach (P = 0.712) or guidance technique (P = 0.295). Complications were rare (1.25% overall: two hematomas, one infection), with no significant intergroup differences (P > 0.05); all resolved with conservative management.
CONCLUSIONS: CEUS-guided transoral biopsy achieved superior technical success with fewer puncture attempts and improved pain control for oropharyngeal lesions, despite modest procedural time extension. This approach demonstrates notable advantages over conventional methods and represents a valuable diagnostic technique for oropharyngeal space lesions.
PMID:41935848 | DOI:10.1016/j.acra.2026.02.033
