Carotid body tumor diagnostic study of choice: Difference between revisions

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__NOTOC__
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{{Carotid body tumor}}
{{Carotid body tumor}}
{{CMG}}; {{AE}} {{Sahar}}
{{CMG}}; {{AE}} {{Sahar}} {{MV}}
== Overview ==
== Overview ==
 
The [[carotid body]] [[tumor]] is [[Diagnose|diagnosed]] primarily by history and [[physical examination]]. However, [[imaging studies]] are necessary to make the final [[diagnosis]]. [[Doppler ultrasound|Color Doppler ultrasound]] has been recommended as a method of [[screening]] for the [[diagnosis]] of [[carotid body]] [[tumor]]. It is also suggested that [[CT angiography]] is more accurate than [[Doppler ultrasound|color Doppler ultrasound]] for the [[diagnosis]] of larger [[lesions]]. [[CT|CT imaging]] combined with [[Doppler ultrasound|color Doppler ultrasound]] has been suggested as the optimal detection [[modality]] for the assessment and management of the [[tumor]]. It should be mentioned that, traditionally, [[digital subtraction angiography]] ([[DSA]]) has been the [[gold standard]] for the [[diagnosis]] of [[carotid body]] [[tumor]].
== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==
*The [[carotid body]] [[tumor]] is [[Diagnose|diagnosed]] primarily by history and [[physical examination]].<ref name="pmid23610583">{{cite journal |vauthors=Luo T, Zhang C, Ning YC, Gu YQ, Li JX, Wang ZG |title=Surgical treatment of carotid body tumor: case report and literature review |journal=J Geriatr Cardiol |volume=10 |issue=1 |pages=116–8 |date=March 2013 |pmid=23610583 |pmc=3627704 |doi=10.3969/j.issn.1671-5411.2013.01.018 |url=}}</ref>
*[[Imaging studies]] are necessary to make the final [[diagnosis]].
*Traditionally, [[digital subtraction angiography]] ([[DSA]]) has been the [[gold standard]] for the [[diagnosis]] of [[carotid body]] [[tumor]].
*However, DSA has been replaced by other [[imaging studies]] such as [[CT angiography]] and [[MR angiography]] which provides an accurate [[angiogram]] as well as information on the local [[extension]] of the [[tumor]] to the adjacent [[tissues]].<ref name="JinHe2016">{{cite journal|last1=Jin|first1=Zhan-Qiang|last2=He|first2=Wen|last3=Wu|first3=Dong-Fang|last4=Lin|first4=Mei-Ying|last5=Jiang|first5=Hua-Tang|title=Color Doppler Ultrasound in Diagnosis and Assessment of Carotid Body Tumors: Comparison with Computed Tomography Angiography|journal=Ultrasound in Medicine & Biology|volume=42|issue=9|year=2016|pages=2106–2113|issn=03015629|doi=10.1016/j.ultrasmedbio.2016.04.007}}</ref>
*[[Doppler ultrasound|Color Doppler ultrasound]] has been recommended as a method of [[screening]] for the [[diagnosis]] of [[carotid body]] [[tumor]].<ref name="WorseyLaborde1992">{{cite journal|last1=Worsey|first1=M.J.|last2=Laborde|first2=A.L.|last3=Bower|first3=T.|last4=Miller|first4=E.|last5=Kresowik|first5=T.F.|last6=Sharp|first6=W.J.|last7=Corson|first7=J.D.|title=An Evaluation of Color Duplex Scanning in the Primary Diagnosis and Management of Carotid Body Tumors|journal=Annals of Vascular Surgery|volume=6|issue=1|year=1992|pages=90–94|issn=08905096|doi=10.1007/BF02000675}}</ref>
**This method is useful in the [[diagnosis]] of Shamblin’s type and intralesional [[blood flow]] of the [[tumor]] before the [[metastasis]].<ref name="JinHe2016">{{cite journal|last1=Jin|first1=Zhan-Qiang|last2=He|first2=Wen|last3=Wu|first3=Dong-Fang|last4=Lin|first4=Mei-Ying|last5=Jiang|first5=Hua-Tang|title=Color Doppler Ultrasound in Diagnosis and Assessment of Carotid Body Tumors: Comparison with Computed Tomography Angiography|journal=Ultrasound in Medicine & Biology|volume=42|issue=9|year=2016|pages=2106–2113|issn=03015629|doi=10.1016/j.ultrasmedbio.2016.04.007}}</ref>
*[[CT|CT imaging]] is useful in the [[diagnosis]] of local [[invasion]] of the [[tumor]] to adjacent [[arteries]] and skull base.
**This method is able to [[differentiate]] the [[tumor]] from other [[paragangliomas]].<ref name="JinHe2016">{{cite journal|last1=Jin|first1=Zhan-Qiang|last2=He|first2=Wen|last3=Wu|first3=Dong-Fang|last4=Lin|first4=Mei-Ying|last5=Jiang|first5=Hua-Tang|title=Color Doppler Ultrasound in Diagnosis and Assessment of Carotid Body Tumors: Comparison with Computed Tomography Angiography|journal=Ultrasound in Medicine & Biology|volume=42|issue=9|year=2016|pages=2106–2113|issn=03015629|doi=10.1016/j.ultrasmedbio.2016.04.007}}</ref>
*[[CT|CT imaging]] combined with [[Doppler ultrasound|color Doppler ultrasound]] has been suggested as the optimal detection [[modality]] for the assessment and management of the [[tumor]].
*Since the [[tumor]] is highly [[vascular]], incisional [[biopsy]] and [[Needle aspiration biopsy|percutaneous needle aspiration]] are [[contraindicated]] and it may cause [[complications]] such as:<ref name="Mirov1962">{{cite journal|last1=Mirov|first1=Andrew G.|title=Benign and Malignant Carotid Body Tumors|journal=JAMA: The Journal of the American Medical Association|volume=181|issue=1|year=1962|pages=13|issn=0098-7484|doi=10.1001/jama.1962.03050270015003}}</ref>
**[[Massive bleeding]]
**[[Pseudoaneurysm]] formation
**[[Carotid]] [[thrombosis]]
==== The comparison of various diagnostic studies for carotid body tumor ====


=== Study of choice ===
Angiography is the gold standard test for the diagnosis of carotid body tumor.
The following result of [gold standard test] is confirmatory of [disease name]:
* [Result 1]
* [Result 2]
OR
[Name of the investigation] must be performed when:
* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.
OR
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
OR
The diagnostic study of choice for [disease name] is [name of the investigation].
OR
There is no single diagnostic study of choice for the diagnosis of [disease name].
OR
There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
OR
[Disease name] is primarily diagnosed based on the clinical presentation.
OR
Investigations:
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
==== The comparison of various diagnostic studies for [disease name] ====
{|
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Accuracy
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
! style="background: #696969; color: #FFFFFF; text-align: center;" |CT angiography
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |100%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |100%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |100%
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
! style="background: #696969; color: #FFFFFF; text-align: center;" |Color Doppler ultrasound
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |89.8%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |82.6%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |87.5%
|}
|}
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>
===== Diagnostic results =====
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
* [Finding 1]
* [Finding 2]


*It is also suggested that [[CT angiography]] is more accurate than [[Doppler ultrasound|color Doppler ultrasound]] for the [[diagnosis]] of larger [[lesions]].<ref name="JinHe2016">{{cite journal|last1=Jin|first1=Zhan-Qiang|last2=He|first2=Wen|last3=Wu|first3=Dong-Fang|last4=Lin|first4=Mei-Ying|last5=Jiang|first5=Hua-Tang|title=Color Doppler Ultrasound in Diagnosis and Assessment of Carotid Body Tumors: Comparison with Computed Tomography Angiography|journal=Ultrasound in Medicine & Biology|volume=42|issue=9|year=2016|pages=2106–2113|issn=03015629|doi=10.1016/j.ultrasmedbio.2016.04.007}}</ref>
*[[Genetic analysis]] should be considered for patients with:<ref name="DavilaChang2016">{{cite journal|last1=Davila|first1=Victor J.|last2=Chang|first2=James M.|last3=Stone|first3=William M.|last4=Fowl|first4=Richard J.|last5=Bower|first5=Thomas C.|last6=Hinni|first6=Michael L.|last7=Money|first7=Samuel R.|title=Current surgical management of carotid body tumors|journal=Journal of Vascular Surgery|volume=64|issue=6|year=2016|pages=1703–1710|issn=07415214|doi=10.1016/j.jvs.2016.05.076}}</ref>
**Positive [[family history]]
** Presence of multiple [[paragangliomas]]
**Those who manifest the [[tumor]] before 50 years of age.
===== Sequence of Diagnostic Studies =====
===== Sequence of Diagnostic Studies =====
The [name of investigation] must be performed when:
*The first line [[Imaging studies|imaging modality]] for the [[diagnosis]] and assessment of the [[tumor]] is [[Doppler ultrasound|Color Doppler ultrasound]].<ref name="JinHe2016">{{cite journal|last1=Jin|first1=Zhan-Qiang|last2=He|first2=Wen|last3=Wu|first3=Dong-Fang|last4=Lin|first4=Mei-Ying|last5=Jiang|first5=Hua-Tang|title=Color Doppler Ultrasound in Diagnosis and Assessment of Carotid Body Tumors: Comparison with Computed Tomography Angiography|journal=Ultrasound in Medicine & Biology|volume=42|issue=9|year=2016|pages=2106–2113|issn=03015629|doi=10.1016/j.ultrasmedbio.2016.04.007}}</ref><ref name="pmid25343084">{{cite journal |vauthors=Tong Y |title=Role of duplex ultrasound in the diagnosis and assessment of carotid body tumour: A literature review |journal=Intractable Rare Dis Res |volume=1 |issue=3 |pages=129–33 |date=August 2012 |pmid=25343084 |doi=10.5582/irdr.v1.3.129 |url=}}</ref>
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
*[[CT|CT imaging]] can be used as the second line [[modality]] for the [[diagnosis]] of selected cases.<ref name="JinHe2016">{{cite journal|last1=Jin|first1=Zhan-Qiang|last2=He|first2=Wen|last3=Wu|first3=Dong-Fang|last4=Lin|first4=Mei-Ying|last5=Jiang|first5=Hua-Tang|title=Color Doppler Ultrasound in Diagnosis and Assessment of Carotid Body Tumors: Comparison with Computed Tomography Angiography|journal=Ultrasound in Medicine & Biology|volume=42|issue=9|year=2016|pages=2106–2113|issn=03015629|doi=10.1016/j.ultrasmedbio.2016.04.007}}</ref>
* A positive [test] is detected in the patient, to confirm the diagnosis.
**Second line [[Imaging studies|imaging modality]] is highly suggested in those with a positive [[family history]] and multi focal [[disease]].
 
OR
 
The various investigations must be performed in the following order:
* [Initial investigation]
* [2nd investigation]
 
=== Name of Diagnostic Criteria ===
=== Name of Diagnostic Criteria ===
 
*There are no established [[criteria]] for the [[diagnosis]] of [[carotid body]] [[tumor]].
'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
 
[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
 
OR
 
There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
 
OR
 
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
[Disease name] may be diagnosed at any time if one or more of the following criteria are met:
* Criteria 1
* Criteria 2
* Criteria 3
 
OR
 
'''IF there are clear, established diagnostic criteria'''
 
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
'''IF there are no established diagnostic criteria'''
 
There are no established criteria for the diagnosis of [disease name].


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 20:49, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2] Maria Fernanda Villarreal, M.D. [3]

Overview

The carotid body tumor is diagnosed primarily by history and physical examination. However, imaging studies are necessary to make the final diagnosis. Color Doppler ultrasound has been recommended as a method of screening for the diagnosis of carotid body tumor. It is also suggested that CT angiography is more accurate than color Doppler ultrasound for the diagnosis of larger lesions. CT imaging combined with color Doppler ultrasound has been suggested as the optimal detection modality for the assessment and management of the tumor. It should be mentioned that, traditionally, digital subtraction angiography (DSA) has been the gold standard for the diagnosis of carotid body tumor.

Diagnostic Study of Choice

The comparison of various diagnostic studies for carotid body tumor

Test Sensitivity Specificity Accuracy
CT angiography 100% 100% 100%
Color Doppler ultrasound 89.8% 82.6% 87.5%
Sequence of Diagnostic Studies

Name of Diagnostic Criteria

References

  1. ↑ Luo T, Zhang C, Ning YC, Gu YQ, Li JX, Wang ZG (March 2013). "Surgical treatment of carotid body tumor: case report and literature review". J Geriatr Cardiol. 10 (1): 116–8. doi:10.3969/j.issn.1671-5411.2013.01.018. PMC 3627704. PMID 23610583.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Jin, Zhan-Qiang; He, Wen; Wu, Dong-Fang; Lin, Mei-Ying; Jiang, Hua-Tang (2016). "Color Doppler Ultrasound in Diagnosis and Assessment of Carotid Body Tumors: Comparison with Computed Tomography Angiography". Ultrasound in Medicine & Biology. 42 (9): 2106–2113. doi:10.1016/j.ultrasmedbio.2016.04.007. ISSN 0301-5629.
  3. ↑ Worsey, M.J.; Laborde, A.L.; Bower, T.; Miller, E.; Kresowik, T.F.; Sharp, W.J.; Corson, J.D. (1992). "An Evaluation of Color Duplex Scanning in the Primary Diagnosis and Management of Carotid Body Tumors". Annals of Vascular Surgery. 6 (1): 90–94. doi:10.1007/BF02000675. ISSN 0890-5096.
  4. ↑ Mirov, Andrew G. (1962). "Benign and Malignant Carotid Body Tumors". JAMA: The Journal of the American Medical Association. 181 (1): 13. doi:10.1001/jama.1962.03050270015003. ISSN 0098-7484.
  5. ↑ Davila, Victor J.; Chang, James M.; Stone, William M.; Fowl, Richard J.; Bower, Thomas C.; Hinni, Michael L.; Money, Samuel R. (2016). "Current surgical management of carotid body tumors". Journal of Vascular Surgery. 64 (6): 1703–1710. doi:10.1016/j.jvs.2016.05.076. ISSN 0741-5214.
  6. ↑ Tong Y (August 2012). "Role of duplex ultrasound in the diagnosis and assessment of carotid body tumour: A literature review". Intractable Rare Dis Res. 1 (3): 129–33. doi:10.5582/irdr.v1.3.129. PMID 25343084.
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