They can also invade the adjacent carotid arteries making surgica

They can also invade the adjacent carotid arteries making surgical management problematic and indicating the need of CBTs as soon as the diagnosis is established. The larger the tumour the more difficult is the resection, and the more neural and vascular injuries occur, so the diagnosis of CBTs should be as earlier as possible.

Lack of clinical diagnosis has been reported in up to 30% of patients since these neoplasm can be confused with enlarged lymph nodes or brachial cysts or salivary glands. The advent of new imaging modalities allow their detection at an earlier stage even before they become clinically evident. CT or MR angiography (MR) are reliable diagnostic techniques to evaluate CBTs and their potential multicentricity or recurrence. The main concerns about CT are the need of contrast medium administration related to potential adverse effects (eg.

acute renal failure) ACP-196 purchase and radiation burden with their inherent risks. MR angiography cannot be performed when patient has pace maker or stainless stell prosthesis. Further limitation to the use of that modality is the ABT-737 nmr risk of nephropaty and nephrogenic systemic fibrosis due contrast medium administration. These drawbacks make those imaging techniques unfit for preclinical screening and 4EGI-1 ic50 long-term follow-up of CBTs. In our experience CCU proved to be useful and very sensitive for detection of CBTs before the onset of symptoms; it also allows the differential diagnosis with other neck mass avoiding ill-advised biopsy. Our experience is consistent with those of several series [11, 12] that indicate Duplex scanning as a non-invasive method for screening evaluation of even small tumours and for their subsequent earlier treatment. This is a crucial point since available reports suggest cranial nerves and vessels injures are more likely Glycogen branching enzyme related to locally advanced disease rather than operative techniques. Ultrasounds study alone may fail in a precise evaluation of size and superior level in the neck of larger tumours when compared with angio-CT and intraoperative

measurements [13]. In our series CCU could establish a definitive diagnosis to proceed with surgery only for tumours less than 2 cm while required further adjunctive instrumental techniques for larger neoplasms. Both CCD and radiological imaging didn’t provide any information for differential diagnosis between chemodectomas and vagus nerve neurinoma that was obtained by 111In-pentetreotide scintigraphy -SPECT scans. Moreover combination of CCU evaluation and 111In-pentreotide scintigraphy -SPECT scans may help not only to localize the suspected paragangliomas at neck but also to determine their nature, size and involvement of adjacent structures on the ground of the tumour’s somatostatin receptors.

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