Carotid body tumor diagnostic study of choice: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{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 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> | *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. | *[[Imaging studies]] are necessary to make the final [[diagnosis]]. | ||
*Traditionally, digital subtraction angiography (DSA) has been the | *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> | *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> | ||
*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> | *[[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> | **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 imaging is useful in the diagnosis of local invasion of the tumor to adjacent arteries and skull base. | *[[CT|CT imaging]] is useful in the [[diagnosis]] of local [[invasion]] of the [[tumor]] to adjacent [[arteries]] and skull base. | ||
**This | **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 imaging combined with color | *[[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 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> | *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 | **[[Massive bleeding]] | ||
**Pseudoaneurysm formation | **[[Pseudoaneurysm]] formation | ||
**Carotid thrombosis | **[[Carotid]] [[thrombosis]] | ||
==== The comparison of various diagnostic studies for carotid body tumor ==== | ==== The comparison of various diagnostic studies for carotid body tumor ==== | ||
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*It is also suggested that CT angiography is more accurate than 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> | *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> | *[[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 | ** Presence of multiple [[paragangliomas]] | ||
**Those who manifest the tumor before 50 years of age. | **Those who manifest the [[tumor]] before 50 years of age. | ||
===== Sequence of Diagnostic Studies ===== | ===== Sequence of Diagnostic Studies ===== | ||
*The first line imaging modality for the diagnosis and assessment of the tumor is 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> | *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> | ||
*CT imaging can be used as the second line modality for the diagnosis of selected cases. | *[[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> | ||
**Second line imaging modality is highly suggested in those with a positive family history and | **Second line [[Imaging studies|imaging modality]] is highly suggested in those with a positive [[family history]] and multi focal [[disease]]. | ||
=== Name of Diagnostic Criteria === | === Name of Diagnostic Criteria === | ||
*There are no established criteria for the diagnosis of carotid body tumor. | *There are no established [[criteria]] for the [[diagnosis]] of [[carotid body]] [[tumor]]. | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Medicine]] | [[Category:Medicine]] | ||
[[Category:Oncology]] | [[Category:Oncology]] | ||
[[Category: | [[Category:Up-To-Date]] | ||
[[Category:Surgery]] | [[Category:Surgery]] | ||
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 carotid body tumor is diagnosed primarily by history and physical examination.[1]
- 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.[2]
- Color Doppler ultrasound has been recommended as a method of screening for the diagnosis of carotid body tumor.[3]
- This method is useful in the diagnosis of Shamblin’s type and intralesional blood flow of the tumor before the metastasis.[2]
- 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.[2]
- CT imaging combined with 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 percutaneous needle aspiration are contraindicated and it may cause complications such as:[4]
- Massive bleeding
- Pseudoaneurysm formation
- Carotid thrombosis
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% |
- It is also suggested that CT angiography is more accurate than color Doppler ultrasound for the diagnosis of larger lesions.[2]
- Genetic analysis should be considered for patients with:[5]
- Positive family history
- Presence of multiple paragangliomas
- Those who manifest the tumor before 50 years of age.
Sequence of Diagnostic Studies
- The first line imaging modality for the diagnosis and assessment of the tumor is Color Doppler ultrasound.[2][6]
- CT imaging can be used as the second line modality for the diagnosis of selected cases.[2]
- Second line imaging modality is highly suggested in those with a positive family history and multi focal disease.
Name of Diagnostic Criteria
- There are no established criteria for the diagnosis of carotid body tumor.
References
- ↑ 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.
- ↑ 2.0 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.