Carotid body tumors: radioguided surgical approach

Abstract

BackgroundCarotid body tumours (CBTs) are very rare lesions which should be treated as soon as possible even when benign since small tumour size permits easier removal and lower incidence of perioperative complications and recurrence. Malignant forms are rare and they can be identified by lymph node invasion and metastases in distant locations. The need of reliable and effective diagnostic modalities for both primary CBTs and its metastases or recurrence is evident.The present study reviews our experience and attempt to define the role of colour coded ultrasound (CCU) and Somatostatin receptor scintigraphy (SRS) with Indium-111-DTPA-pentetretide (Octreoscan®) using both planar and single photon emission tomography (SPECT) technique in the diagnosis and follow-up of these uncommon lesions within a multidisciplinary approach.MethodsFrom 1997 to 2008, 12 patients suffering from 16 CBTs (4 bilateral) were investigated by CCU and SRS-SPECT before and after surgery. All tumours were grouped according to Shamblin's classification in order to assess the technical difficulties and morbidity of surgical resection on the ground of their size and relationship with the carotid arteries. Intraoperative radiocaptation by Octreoscan®) was also carried out in all cases to evaluate the radicality of surgery. All perioperative scans were evaluated by the same nuclear medicine physician.ResultsPreoperatively CCU showed CBTs (four were not palpable) with a sensitivity of 100%. Radioisotope imaging identified the CBTs as chemodectomas in 15 cases while no radioisotopic uptake was detected in 1 vagus nerve neurinoma. No evidence of metastasis or multicentricity were seen by total body radioisotopic scans. Combined data from CCU and SRS-SPECT allowed to determine tumour size in order to select 7 larger tumours which were submitted to selective preoperative embolization.Intraoperatively Octreoscan demonstrated microscopic tumour leftovers promptly removed in 1 case and an unresectable remnant at the base of the skull in another case.During follow-up CCI and radioisotope scans showed no recurrence in 14 cases and a slightly enlargement of the intracranial residual as detected during surgery in 1 patient.ConclusionCCU may allow an early and noninvasive detection of CBTs and hence safer operations. The combined use of CCU and SRS-SPECT provide useful data to identify those tumours and to evaluate their extent and carotid arteries infiltration. Radioisotope imaging is a sensitive modality to detect metastases and lymph node involvement that are markers of CBT malignancy. After surgery CCU and SRS-SPECT can be accurate modalities for surveillance for an early detection of CBTs recurrence.

Carotid Body Tumors: A Review of 25 Years Experience in Diagnosis and Management of 56 Tumors

“…12,14,15) Color coded ultrasonography (CCU) allows early and non-invasive accurate detection of tumors with 100% sensitivity even when not palpable. 16) The combined use of CCU and somatostatin receptor scintigraphy with planar and single photon emission tomography was found beneficial in identifying the extent of tumors, and degree of arterial infiltration. 14) CT and MRI show the infiltration in the neck and in between the vessels.…”

Carotid Body Tumors and Our Surgical Approaches

“…CCU allows an early and noninvasive detection of the tumor. The combined use of CCU and somatostatin receptor scintigraphy with both planar and single photon emission tomography provides effective data to identify the tumors and to evaluate their extent and carotid artery infiltration [13].…”

Cirugía radioguiada de tumores neuroendocrinos. Revisión de la literatura

“…Martinelli et al 55 incluyen 12 pacientes con tumor de cuerpo carotídeo, en los que se realizó la intervención a las 24 horas de inyectar 150 MBq de 111 In-pentetreotida. Los autores apoyan el uso de ecografía, unida a la gammagrafía, para la localización prequirúrgica de los paragangliomas cervicales, y para determinar su naturaleza, tamaño y afectación de estructuras adyacentes, además de la detección de metástasis a distancia mediante rastreo corporal total.…”