Radioguided surgical resection of carotid body tumors

Aim: We present our experience about surgical resection of carotid body tumor (CBT) and to define the role ofcolour coded ultrasound (CCU) and of somatostatin receptor scintigraphy (SRS) with Indium-111-DTPA-pentreotide(Octreoscan®) using both planar and single photon emission tomography (SPECT) technique.Methods: Twenty-three patients suffering from 27 CBTs were treated from 1997 to 2014. Preoperativeinvestigations included CCU and SRS-SPECT. All tumours were grouped according to Shamblin's classification.Intraoperative radiocaptation by Octreoscan was also carried out in all cases to evaluate the radicality of surgery.Results: Preoperatively CCU showed CBTs with sensitivity 100%. Radioisotope imaging identified the CBTs ascarotid body tumors in 25 cases while no radio isotopic uptake was detected in 2 cervical vagal schwannoma.Combined data from CCU and SPECT allowed determining tumour size in order to select 12 larger tumours.Intraoperative Octreoscan demonstrated microscopic tumour leftovers promptly removed in 2 cases and anunrespectable remnant at the base of skull in another case.During follow-up (6 months-10 years, mean 3.9 years) CCU and radioisotope scans showed no recurrence in 25cases, a slightly enlargement of that intracranial residual as detected during surgery in 1 patients and a littlerecurrence in another one case.Conclusion: CCU may allow an early and noninvasive detection of CBTs and hence safer operations. Thecombined use of CCU and SPECT provide useful data to identify that tumour and to evaluate their extent andcarotid arteries infiltration. Radioisotope imaging is a sensitive modality to detect metastases and lymph nodeinvolvement that are markers of CBT malignancy. Mid and long terms results in terms of recurrence and carotidrepairs patency seems very encouraging with this approach. After surgery CCU and SPECT seem to be accuratemodalities for surveillance for an early detection of CBTs recurrence