SRS326 - How accurately can carotid body tumours be distinguished from nerve neck paraganglionomas on imaging? An audit

Abstract Introduction Neck paragangliomas require surgical excision when they are secretory, malignant, or symptomatic. Preoperative distinction between carotid body tumours (CBTs) and nerve-associated paragangliomas (for example vagal) is essential for optimal surgical planning and informed patient consent. Vagal tumour excision may result in dysphagia, hoarseness, cardiac arrhythmias, gastrointestinal disturbance and autonomic dysfunction. Conversely, CBT excision is associated with risk of perioperative stroke, making preoperative diagnosis crucial for patient safety. Methods Ten anonymised images of neck paragangliomas (five CBTs) were reviewed by ninety healthcare professionals of varying expertise, ranging from nurses to consultant surgeons. Participants were asked to identify tumour type. Four key distinguishing imaging features were then outlined, and participants re-assessed the same images. Diagnostic accuracy was analysed by tumour type, professional role, imaging modality (CT versus MRI), and image orientation (transverse versus longitudinal planes). Results Initial diagnostic accuracy of participants was 65%. Binary logistic regression suggested a significantly higher accuracy among consultant reviewers and when using CT imaging (P < 0.01), while no significant difference was observed for tumour type. After awareness of distinguishing imaging features, overall diagnostic accuracy improved substantially to 81%, with CBTs showing significantly better identification rates (P < 0.05). MRI imaging and non-consultant reviewers were consistently associated with lower diagnostic confidence levels. Conclusions Preoperative identification of neck paraganglioma subtype remains diagnostically challenging across healthcare professionals of all experience levels. However, targeted education about key imaging features significantly improves diagnostic accuracy, particularly for carotid body tumours. These findings have immediate clinical implications for surgical planning, perioperative risk stratification, and comprehensive patient counselling.