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Piazza C, Montenegro C, Rampinelli V. Bilateral carotid body tumor management: tips, tricks, strategies, and problems. Curr Opin Otolaryngol Head Neck Surg 2025:00020840-990000000-00170. [PMID: 39903657 DOI: 10.1097/moo.0000000000001035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2025]
Abstract
PURPOSE OF REVIEW Carotid body tumors (CBTs) are rare neuroendocrine tumors with an annual incidence of 1 : 30 000. Bilateral carotid body tumors (BCBTs) account for 3-5% of all CBTs and are more frequently linked to familial syndromes and potential malignancy. BCBT management is still not universally standardized and depends on multiple factors, including patient's age, risk of malignancy, location, growth rate, size, and related Shamblin and Mehanna classifications. RECENT FINDINGS Options of treatment include active surveillance, external beam radiation, and surgery. Surgery is the first-choice treatment, but it may not always be performed especially in elderly patients. Simultaneous BCBT resection is not suggested due to high intra-operative and postoperative risks. The decision to operate on the larger or smaller tumor first is still debated. Whenever feasible, treatment of the larger tumor first to reduce the tumor burden should be preferred but with higher risks of neurovascular injury. Conversely, starting with the smaller tumor first offers a lower risk at initial surgery but may complicate the management of the larger tumor later. SUMMARY Surgery for BCBTs, whenever feasible, remains the most indicated treatment but poses a significant risk of neurovascular complications. Resection of the larger, often more symptomatic, and potentially problematic or malignant tumor, reduces the overall disease burden and mitigates risks of rapid progression but involves a higher immediate complication hazard. Multidisciplinary evaluation is essential for balancing surgical risks and long-term outcomes, prioritizing neurovascular preservation and reducing morbidity.
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Affiliation(s)
- Cesare Piazza
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Claudia Montenegro
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
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Wang H, Li Z, Yao C, Wang M, Hu Z, Wu R, Chang G. Perioperative Evaluation and Follow-Up Analysis of Carotid Body Tumor by Color Doppler Ultrasound. Ann Vasc Surg 2025; 110:126-132. [PMID: 39009121 DOI: 10.1016/j.avsg.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/17/2024] [Accepted: 05/02/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND The value of color doppler ultrasound (CDU) for perioperative evaluation and follow-up outcomes of carotid body tumor (CBT) remains elusive. This study aimed to investigate the role of CDU in CBT in our center. METHODS From January 2015 to December 2020, 75, patients with CBT were included in the study. Computed tomography angiography (CTA) and CDU data of patients were collected and analyzed. The postoperative recovery and follow-up outcomes were summarized. RESULTS A total of 91 CBTs in 75 patients were included in the study. 73.3% of the patients had unilateral lesions, while 26.7% had bilateral lesions. Lesions were categorized as Shamblin I (4.4%), Shamblin II (52.7%), and Shamblin III (42.9%). 79.5% lesions were treated by surgical resection, 12.3% were treated by surgical resection with internal carotid artery reconstructed by artificial vessel, while 8.2% were treated by surgical resection with internal carotid artery reconstructed by autogenous great saphenous vein. Compared with CTA, the sensitivity of CDU for the detection of CBT was 96.7%, the sensitivity and specificity of CDU for the detection of Shamblin I lesions were both 100%, the sensitivity and specificity for Shamblin II were 100% and 72.1%, respectively, while the sensitivity and specificity for Shamblin III were 69.2% and 100%, respectively. There were no statistically significant differences between CTA and CDU for the detection of the maximal diameter, volume of CBT, distance between the end of the tumor, and the mastoid process. 79.7% of the patients were followed up with CDU. The eecurrence of CBT occurred in 1 patient. CDU showed that stenosis and occlusion of artificial vessel occurred in 1 and 6 patients, respectively. The occlusion of autogenous great saphenous vein was found in 2 cases. CONCLUSIONS CDU can accurately diagnose Shamblin I CBT, have high sensitivity for Shamblin II, and high specificity for Shamblin III CBT. It plays an important role in diagnosis, perioperative evaluation, and follow-up analysis of CBT.
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Affiliation(s)
- Hui Wang
- Department of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zilun Li
- Department of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chen Yao
- Department of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mian Wang
- Department of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zuojun Hu
- Department of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ridong Wu
- Department of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guangqi Chang
- Department of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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David E, Grazhdani H, Aliotta L, Gavazzi LM, Foti PV, Palmucci S, Inì C, Tiralongo F, Castiglione D, Renda M, Pacini P, Di Bella C, Solito C, Gigli S, Fazio A, Bella R, Basile A, Cantisani V. Imaging of Carotid Stenosis: Where Are We Standing? Comparison of Multiparametric Ultrasound, CT Angiography, and MRI Angiography, with Recent Developments. Diagnostics (Basel) 2024; 14:1708. [PMID: 39202195 PMCID: PMC11352936 DOI: 10.3390/diagnostics14161708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/22/2024] [Accepted: 07/26/2024] [Indexed: 09/03/2024] Open
Abstract
Atherosclerotic disease of the carotid arteries is a crucial risk factor in predicting the likelihood of future stroke events. In addition, emerging studies suggest that carotid stenosis may also be an indicator of plaque load on coronary arteries and thus have a correlation with the risk of acute cardiovascular events. Furthermore, although in symptomatic patients the degree of stenosis is the main morphological parameter studied, recent evidence suggests, especially in asymptomatic patients, that plaque vulnerability should also be evaluated as an emerging and significant imaging parameter. The reference diagnostic methods for the evaluation of carotid stenosis are currently ultrasonography, magnetic resonance imaging (MRI), and computed tomography angiography (CTA). In addition, other more invasive methods such as 123I-metaiodobenzylguanidine (MIBG) scintigraphy and PET-CT, as well as digital subtraction angiography, can be used. Each method has advantages and disadvantages, and there is often some confusion in their use. For example, the usefulness of MRI is often underestimated. In addition, implementations for each method have been developed over the years and are already enabling a significant increase in diagnostic accuracy. The purpose of our study is to make an in-depth analysis of all the methods in use and in particular their role in the diagnostic procedure of carotid stenosis, also discussing new technologies.
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Affiliation(s)
- Emanuele David
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, 95125 Catania, Italy; (L.A.); (L.M.G.); (P.V.F.); (S.P.); (C.I.); (F.T.); (D.C.); (A.F.); (R.B.); (A.B.)
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00185 Rome, Italy
| | | | - Lorenzo Aliotta
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, 95125 Catania, Italy; (L.A.); (L.M.G.); (P.V.F.); (S.P.); (C.I.); (F.T.); (D.C.); (A.F.); (R.B.); (A.B.)
| | - Livio Maria Gavazzi
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, 95125 Catania, Italy; (L.A.); (L.M.G.); (P.V.F.); (S.P.); (C.I.); (F.T.); (D.C.); (A.F.); (R.B.); (A.B.)
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, 95125 Catania, Italy; (L.A.); (L.M.G.); (P.V.F.); (S.P.); (C.I.); (F.T.); (D.C.); (A.F.); (R.B.); (A.B.)
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, 95125 Catania, Italy; (L.A.); (L.M.G.); (P.V.F.); (S.P.); (C.I.); (F.T.); (D.C.); (A.F.); (R.B.); (A.B.)
| | - Corrado Inì
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, 95125 Catania, Italy; (L.A.); (L.M.G.); (P.V.F.); (S.P.); (C.I.); (F.T.); (D.C.); (A.F.); (R.B.); (A.B.)
| | - Francesco Tiralongo
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, 95125 Catania, Italy; (L.A.); (L.M.G.); (P.V.F.); (S.P.); (C.I.); (F.T.); (D.C.); (A.F.); (R.B.); (A.B.)
| | - Davide Castiglione
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, 95125 Catania, Italy; (L.A.); (L.M.G.); (P.V.F.); (S.P.); (C.I.); (F.T.); (D.C.); (A.F.); (R.B.); (A.B.)
| | - Maurizio Renda
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (M.R.); (P.P.); (C.D.B.); (C.S.); (V.C.)
| | - Patrizia Pacini
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (M.R.); (P.P.); (C.D.B.); (C.S.); (V.C.)
| | - Chiara Di Bella
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (M.R.); (P.P.); (C.D.B.); (C.S.); (V.C.)
| | - Carmen Solito
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (M.R.); (P.P.); (C.D.B.); (C.S.); (V.C.)
| | - Silvia Gigli
- Department of Diagnostic Imaging, Sandro Pertini Hospital, Via dei Monti Tiburtini, 385, 00157 Rome, Italy;
| | - Alessandro Fazio
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, 95125 Catania, Italy; (L.A.); (L.M.G.); (P.V.F.); (S.P.); (C.I.); (F.T.); (D.C.); (A.F.); (R.B.); (A.B.)
| | - Rita Bella
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, 95125 Catania, Italy; (L.A.); (L.M.G.); (P.V.F.); (S.P.); (C.I.); (F.T.); (D.C.); (A.F.); (R.B.); (A.B.)
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, 95125 Catania, Italy; (L.A.); (L.M.G.); (P.V.F.); (S.P.); (C.I.); (F.T.); (D.C.); (A.F.); (R.B.); (A.B.)
| | - Vito Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (M.R.); (P.P.); (C.D.B.); (C.S.); (V.C.)
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Nashnoush M, Lad M, Masood I, Singh A, Sazzad S, Bharmal S, Negussie M, Marwan M, Eskander S. Multiparametric analysis of carotid body tumours: a pictorial essay. J Ultrasound 2023; 26:553-561. [PMID: 36114987 PMCID: PMC10247662 DOI: 10.1007/s40477-022-00711-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
Abstract
Carotid body tumours (CBT), also called carotid body paraganglioma, are highly vascular and histologically portray paraganglion cells. They are typically found at the carotid bifurcation and result in the splaying of the internal and external carotid arteries (ICA and ECA). Recent literature supports the role of chronic hypoxia in the etiology of CBT. This pictorial essay discusses how CBT is an uncommon etiology for common clinical problems such as transient ischemic attacks. It also discusses imaging techniques to precisely map out the tumour for surgical resection using advanced imaging modalities and techniques.
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Affiliation(s)
- Mohamed Nashnoush
- School of Health Sciences, Dalhousie University, 1278 Tower Road, Halifax, NS, B3H 2Y7, Canada.
| | - Mrinal Lad
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Isha Masood
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Arjun Singh
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Sadman Sazzad
- Alumni of Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Sidra Bharmal
- Faculty of Science, University of Western Ontario, London, ON, Canada
| | - Michael Negussie
- School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Menna Marwan
- Faculty of Medicine, Port Said University, Port Said, Egypt
| | - Sherry Eskander
- Department of Biology, University of Toronto, Toronto, ON, Canada
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Centello R, Sesti F, Feola T, Sada V, Pandozzi C, Di Serafino M, Pacini P, Cantisani V, Giannetta E, Tarsitano MG. The Dark Side of Ultrasound Imaging in Parathyroid Disease. J Clin Med 2023; 12:jcm12072487. [PMID: 37048571 PMCID: PMC10095081 DOI: 10.3390/jcm12072487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/14/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
The diagnosis of parathyroid diseases by imaging still has some intrinsic technical limitations due to the differential diagnosis of different structures of the neck that mimic the parathyroid glands. In this view, ultrasound (US) is an established, low-cost, and non-invasive imaging technique that still represents the first-line approach for evaluating patients with parathyroid disease. The objective of this article is to provide a comprehensive review of the applications of USs in clinical practice, discussing the histopathological and US characteristics of the parathyroid glands in normal and pathological conditions, the advantages of preoperative imaging, and novel updates on the most useful and currently available multiparameter US techniques.
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Xu L, Kang Y, Wen X. A Case Report of a Bilateral Carotid Body Tumor and a Review of Its Imaging Manifestations. J Belg Soc Radiol 2023; 107:23. [PMID: 37034108 PMCID: PMC10077979 DOI: 10.5334/jbsr.2952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/23/2023] [Indexed: 04/11/2023] Open
Abstract
Bilateral carotid body tumors (CBTs) are extremely uncommon. In recent years, some clinical cases have been documented. A case of bilateral CBT is reported with a review of its imaging manifestations. When a unilateral CBT is discovered, assessment of the contralateral site is essential. The 'goblet' sign is a characteristic imaging feature of CBT. The preferred imaging modality is computed tomography angiography. Teaching Point When a carotid body tumor is suspected on one side, careful examinationof the contralateral side is essential; The preferred imaging approach is CTA.
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Affiliation(s)
- Long Xu
- Ziyang People’s Hospital, CN
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