Core Biopsy of Cervical Lymph Node
This chapter provides a comprehensive procedural report for core biopsy of cervical lymph node procedure, with up-to-date explanatory notes, synopsis of the indications and contraindications, and potential complications in an organized and practical forma
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Core Biopsy of Cervical Lymph Node Sahar Semaan and Marc Mourad
INTRODUCTION Percutaneous needle biopsy of enlarged cervical lymph nodes using ultrasound or CT guidance is a relatively safe procedure for patients with a suspected pathologic cervical adenopathy and has low morbidity and mortality rates. It is important to monitor the patient following the procedure for a short period of time and to track the biopsy results to insure the safety and efficacy of the procedure.
COMMON CONTRAINDICATIONS [1, 3, 4] There are no absolute contraindications. The relative contraindications to be considered include the following: • Severe uncorrectable coagulopathy • Hemodynamic instability • Lack of a safe pathway to the lymph node • Lack of patient cooperation
POSSIBLE COMPLICATIONS [1, 4] COMMON INDICATIONS [1–3] • Determination of the benign or malignant nature of the lymph node • Microbiologic analysis in suspected infection • Staging patients with known malignancy and suspected metastasis
S. Semaan (&) Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029-6574, USA e-mail: [email protected] M. Mourad Department of Head and Neck and Endocrine Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA e-mail: [email protected]
• Vascular injury (especially to the carotid arteries) • Tracheal injury • Hemorrhage • Superinfection • Pneumothorax (particularly in supraclavicular nodes) • Vasovagal reaction
PREPROCEDURAL ASSESSMENT AND PLANNING • History, indications and physical examination (Appendix 1 in Chap. 149) • Evaluation of diagnostic imaging studies (ultrasound, computed tomography, PET-CT, and/or magnetic resonance imaging): to
© Springer International Publishing Switzerland 2016 B. Taslakian et al. (eds.), Procedural Dictations in Image-Guided Intervention, DOI 10.1007/978-3-319-40845-3_1
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S. Semaan and M. Mourad
determine the location of the lymph node of interest and the relevant anatomy Periprocedural management of coagulation status (Appendices 2 in Chap. 150 and 3 in Chap. 151) Antibiotic prophylaxis: Not routinely recommended [5] (Appendices 4 in Chap. 152 and 5 in Chap. 153) Imaging modality for guidance: Ultrasound/CT guidance Positioning: Oblique/prone/supine (depending on the location of the target lymph node)
PROCEDURE NOTE Procedure: CT/ultrasound-guided core biopsy of left/right cervical lymph node Staff: [_] Fellow: [_] Resident: [_] Clinical History and Indications: Describe history and list indications Allergies: None known/Allergic to [specify/type of allergy] Anesthesia: Local anesthesia/Conscious sedation Medications: List any relevant medications used (sedation, antibiotics) Field: Sterile Procedure classification: Clean Position: Supine/Oblique/Prone Monitoring: Intravenous access line was secured and vital signs were continuously monitored by nursing staff/anesthesia team throughout the procedure Cumulative radiation dose: (_) mGy Description of Procedure: The risks, benefits, and procedur
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