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

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.