Diagnostic Performance and Radio–Pathologic Correlation of Image-Guided Biopsy in Head and Neck Lesions: A Systematic Review

Abstract

Background: Accurate diagnosis of head and neck lesions relies heavily on image-guided biopsy techniques, which facilitate targeted sampling and enable radiologic–pathologic correlation. Increasing use of CT-guided fine-needle aspiration cytology (FNAC) and core-needle biopsy (CNB) necessitates updated evaluation of their diagnostic performance and safety. To systematically identify, appraise, and synthesize published evidence on the diagnostic accuracy, tissue adequacy, and radio–pathologic concordance of image-guided biopsy for head and neck lesions. Materials and Methods: This review followed PRISMA 2020 guidelines and a protocol registered in PROSPERO (CRD420251181567). Searches were conducted across PubMed/MEDLINE, Scopus, Cochrane Library, Web of Science, and Google Scholar (January 2018–September 2025). Eligible studies included human subjects undergoing image-guided FNAC or CNB with reported diagnostic outcomes. Two reviewers independently screened, extracted data, and assessed quality using QUADAS-2. Due to methodological and clinical heterogeneity, meta-analysis was not performed. Results: From 345 records, eight studies met inclusion criteria. Most were retrospective (8/10), evaluating CT-guided FNAC, CNB, or percutaneous needle biopsy across cervical, suprahyoid, salivary, lymphatic, thyroid, and skull base lesions. Diagnostic sensitivities ranged from 85–95%, specificities from 92–97%, and overall accuracies from 90–96%. Diagnostic yield was high (85–100%), and radio–pathologic concordance consistently exceeded 87%. Complications were uncommon and generally minor, except for hilar lymph node biopsies, which showed higher pneumothorax rates. Conclusion: Image-guided biopsy of head and neck lesions demonstrates high diagnostic accuracy and excellent radio–pathologic concordance across diverse anatomic regions, supporting its role as a reliable, minimally invasive diagnostic tool. Despite strong performance in deep and complex spaces, procedure-specific complication risks—particularly in hilar lymph node sampling—should inform clinical decision-making.