CONTEXT: sporadic head and neck paragangliomas often represent familial paraganglioma syndrome (FPS). FPS patients require close follow-up, and family members will benefit from screening. No clear guideline for following these patients exists in the otolaryngology literature. OBJECTIVE: to present a series of FPS patients, illustrating the importance of a cost-effective FPS genetic screening algorithm applicable in otolaryngology. DESIGN: case series, literature review, clinical guidelines. SETTING: tertiary care hospital. PATIENTS: adult patients with SDHx mutations were identified in the University of Alberta's head and neck mass database. Medical records were reviewed for presentation, diagnosis, findings, treatment, follow-up, and genetic testing. A literature review of FPS clinical features, treatment, and genetic screening methods was performed. INTERVENTION: genetic screening. MAIN OUTCOME MEASURE: cost-effectiveness of genetic testing for FPS screening. RESULTS: two patients with FPS were surgically treated by otolaryngologists. All patients presented with multifocal disease and carried SDHB or SDHD mutations. A screening and genetic testing protocol was implemented leading to early detection in a third patient, thus reducing morbidity. The literature review supports the contention that all patients with head and neck paragangliomas should undergo genetic testing. An algorithm to screen such patients is proposed. Cost analysis showed savings of over $2400 ($US 2200) every 6 years with this approach. CONCLUSION: owing to the potential morbidity associated with head and neck paragangliomas, it is prudent that FPS be ruled out. Those found to have SDHx mutations, and first-degree relatives, should be offered genetic testing with enrolment in a screening protocol. This provides a cost-effective, early detection approach to FPS.
CONTEXT: sporadic head and neck paragangliomas often represent familial paraganglioma syndrome (FPS). FPS patients require close follow-up, and family members will benefit from screening. No clear guideline for following these patients exists in the otolaryngology literature. OBJECTIVE: to present a series of FPS patients, illustrating the importance of a cost-effective FPS genetic screening algorithm applicable in otolaryngology. DESIGN: case series, literature review, clinical guidelines. SETTING: tertiary care hospital. PATIENTS: adult patients with SDHx mutations were identified in the University of Alberta's head and neck mass database. Medical records were reviewed for presentation, diagnosis, findings, treatment, follow-up, and genetic testing. A literature review of FPS clinical features, treatment, and genetic screening methods was performed. INTERVENTION: genetic screening. MAIN OUTCOME MEASURE: cost-effectiveness of genetic testing for FPS screening. RESULTS: two patients with FPS were surgically treated by otolaryngologists. All patients presented with multifocal disease and carried SDHB or SDHD mutations. A screening and genetic testing protocol was implemented leading to early detection in a third patient, thus reducing morbidity. The literature review supports the contention that all patients with head and neck paragangliomas should undergo genetic testing. An algorithm to screen such patients is proposed. Cost analysis showed savings of over $2400 ($US 2200) every 6 years with this approach. CONCLUSION: owing to the potential morbidity associated with head and neck paragangliomas, it is prudent that FPS be ruled out. Those found to have SDHx mutations, and first-degree relatives, should be offered genetic testing with enrolment in a screening protocol. This provides a cost-effective, early detection approach to FPS.
Authors: Matthias Miederer; Christian Fottner; Heidi Rossmann; Andreas Helisch; Konstantinos Papaspyrou; Oliver Bartsch; Wolf J Mann; Thomas J Musholt; Matthias M Weber; Karl J Lackner; Mathias Schreckenberger Journal: Eur J Nucl Med Mol Imaging Date: 2013-02-02 Impact factor: 9.236