title: A probabilistic assessment of the diagnosis of paraganglioma/pheochromocytoma based on clinical criteria and biochemical/imaging findings.
abstract: Paragangliomas (PGL) and pheochromocytomas (P) are rare neural-crest-derived neoplasms. Very recently guidelines on diagnosis and treatment of PGL/P have been presented by the US Endocrine Society. In the following overview we assessed the implementation of these guidelines with probabilistic reasoning (calculating with Fagan nomograms the post-test probability of PGL/P for a given pre-test probability).
  
  
  CONCLUSIONS
  Biochemical evaluation of PGL/P showed excellent diagnostic characteristics with post-test probabilities that are very different from the pre-test probabilities, thus a positive biochemical test is usually indicative of disease whereas a negative one usually rules out disease. The post-test probabilities of anatomical and functional imaging modalities (i.e. in nuclear medicine) were different from the pre-test probabilities but to a lesser degree than the biochemical tests; furthermore in biochemically-proven PGL/P a negative imaging modality is not useful, while a positive one may indicate only one of multiple foci of metastatic/extra-adrenal disease. Thus, regarding imaging modalities, they should be combined in order to get the most of their characteristics for the localization of PGL/P.
authors.affiliation: Department of Nuclear Medicine, Hippokration General Hospital, Konstantinoupoleos St. 49, P.C. 546 42, Thessaloniki, Macedonia, Greece. meristoudis@yahoo.gr.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Ilias
authors.forename: Georgios
authors.initials: G
authors.lastname: Meristoudis
authors.forename: Athanasios
authors.initials: A
authors.lastname: Notopoulos
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis*; D019788:Fluorodeoxyglucose F18; D006801:Humans; D009362:Neoplasm Metastasis; D009380:Neoplasms, Nerve Tissue / Q000175:diagnosis* / Q000000981:diagnostic imaging; D009432:Neural Crest / Q000473:pathology*; D049451:Nomograms; D009683:Nuclear Medicine / Q000379:methods; D010235:Paraganglioma / Q000175:diagnosis* / Q000000981:diagnostic imaging; D010673:Pheochromocytoma / Q000175:diagnosis* / Q000000981:diagnostic imaging; D049268:Positron-Emission Tomography / Q000379:methods; D017410:Practice Guidelines as Topic; D011336:Probability; D012680:Sensitivity and Specificity
chemical_list: D019788:Fluorodeoxyglucose F18