Navigation-guided biopsy of retropharyngeal lymph nodes

The impact of metastasis to the retropharyngeal lymph node group is poorly understood because of the difficult access to the retropharyngeal space (RPS). In 20%–50% of surgically treated oropharyngeal, hypopharyngeal, and cervical oesophageal carcinomas, we can find metastases to the retropharyngeal lymph nodes (RPLNs). (1) The use of a three-dimensional (3D)-imaging-guided navigation system to perform a biopsy for a suspicion of metastasis in an RPLN can provide advantages in terms of better precision and 3D orientation with protection of the surrounding critical structures. We report two cases of an open biopsy by transoral and transnasal approaches for a suspicion of metastasis in a retropharyngeal lymph node in two patients with oropharyngeal and pulmonary cancer, respectively, by using the 3D imaging-guided navigation system. In the both cases, the biopsies performed were very accurate and allowed to get a full histological analysis and diagnosis. The use of the navigation system as a means to perform biopsies in the soft tissue of the neck is rarely reported and up to date few reports can be found in the literature. This technique can provide multiple advantages when compared with other conventional methods. The procedure is simple, safe and minimally invasive.